Chapter 18 My Nursing Test Banks

Kozier & Erbs Fundamentals of Nursing, 10/E
Chapter 18

Question 1

Type: MCMA

A community health nurse is learning about the REACH initiative and has decided to implement community education on this approach. What topics should the nurse include in this education?

Standard Text: Select all that apply.

1. Child and adult immunizations

2. Cardiovascular disease

3. Chronic lower respiratory disease

4. Stroke

5. Infant mortality

Correct Answer: 1, 2, 5

Rationale 1: REACH: Racial and Ethnic Approaches to Community Health is an initiative of the Centers for Disease Control and Prevention. Topics within the REACH initiative include child and adult immunizations.

Rationale 2: REACH: Racial and Ethnic Approaches to Community Health is an initiative of the Centers for Disease Control and Prevention. Topics within the REACH initiative include cardiovascular diseases.

Rationale 3: REACH: Racial and Ethnic Approaches to Community Health is an initiative of the Centers for Disease Control and Prevention. Chronic lower respiratory disease is not a topic within the REACH initiative.

Rationale 4: REACH: Racial and Ethnic Approaches to Community Health is an initiative of the Centers for Disease Control and Prevention. Stroke is not a topic within the REACH initiative.

Rationale 5: REACH: Racial and Ethnic Approaches to Community Health is an initiative of the Centers for Disease Control and Prevention. Topics within the REACH initiative include infant mortality.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe the role of federal agencies and initiatives regarding the provision of culturally responsive health care.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 279

Question 2

Type: MCSA

A new graduate nurse is working in a busy emergency department of a hospital, situated in a culturally diverse area of the city. In striving to be culturally sensitive, what should the nurse do?

1. Try to learn about the attitudes toward health care and traditions of the different cultures in that area.

2. Understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills.

3. Possess the underlying background knowledge that will provide these clients with the best possible health care.

4. Continuously strive to be culturally competent.

Correct Answer: 1

Rationale 1: Cultural sensitivity implies that nurses possess some basic knowledge of and constructive attitudes toward the health traditions observed among the diverse cultural groups found in the setting in which they are practicing.

Rationale 2: To understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills, is a general nursing expectation and does not address cultural sensitivity directly.

Rationale 3: To possess the underlying background knowledge that will provide these clients with the best possible health care is a general nursing expectation and does not address cultural sensitivity directly.

Rationale 4: Becoming culturally competent is an ongoing process in which an individual develops along a continuum until diversity is accepted as a norm and the nurse has acquired greater understanding and capacity in a diverse environment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment..

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 288

Question 3

Type: MCSA

A client is the child of an African American father and Asian American mother. The client has been exposed to cultural foods, traditions, and customs from both parents throughout life. What term should the nurse use to describe this clients cultural development?

1. Diversity

2. Subculture

3. Multicultural

4. Cultural sensitivity

Correct Answer: 3

Rationale 1: Diversity refers to the fact or state of being different.

Rationale 2: A subculture is usually composed of people who have a distinct identity yet are related to a larger cultural group.

Rationale 3: Multicultural is used to describe a person who has multiple patterns of identification or crosses several cultures, lifestyles, and sets of values.

Rationale 4: Nurses demonstrate cultural sensitivity when they possess some basic knowledge of and constructive attitudes toward the health traditions observed among the diverse cultural groups found in a setting in which they are practicing.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe concepts related to culture such as race, ethnicity, and acculturation.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 277

Question 4

Type: MCSA

A nurse is working with a home health client whose spouse was not born in the United States. During the home visit, the nurse realizes that the client has acquired the identity of her spouses culture and has adopted some of the health practices of that culture. Which process should the nurse identify as occurring with the spouse?

1. Acculturation

2. Assimilation

3. Diversity

4. Heritage consistency

Correct Answer: 2

Rationale 1: Acculturation occurs when people adapt to or borrow traits from another culture. Acculturation can also be defined as the changes of ones cultural patterns to those of the host society.

Rationale 2: Assimilation is the process by which an individual develops a new cultural identity. It encompasses various aspects such as

behavior, marital roles, identification, and civic duties. The underlying assumption is that the person from a given cultural group loses his or her original cultural identity to acquire the new one.

Rationale 3: Diversity is the fact or state of being different.

Rationale 4: Heritage consistency relates to the observance of beliefs and practices of a persons traditional cultural system.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe concepts related to culture such as race, ethnicity, and acculturation.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 279

Question 5

Type: MCSA

The nurse manager is concerned that a staff nurse provides client care with a cultural prejudice. Which situation did the manager observe to come to this conclusion?

1. Making an assumption that all members of each culture are alike

2. Believing that all culture members will have the same beliefs

3. Bringing previous negative information and experiences into this situation

4. Taking general knowledge from literature and applying it to the situation

Correct Answer: 3

Rationale 1: Making an assumption that all members of each culture are alike describes stereotypical behavior.

Rationale 2: Believing that all culture members have the same beliefs describes stereotypical behavior.

Rationale 3: Prejudice is a negative belief or preference that is generalized about a group, which leads to prejudgment. Prejudice occurs when the person making the judgment generalizes an experience of one individual from a culture to all members of that group.

Rationale 4: Taking general knowledge from literature and applying it to the situation is a form of stereotyping.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8. Create self-awareness of your own culture, beliefs, biases, and assumptions.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 278

Question 6

Type: MCSA

A new graduate nurse is moving from a small rural college town to a metropolitan area to begin work in a county hospital. The nurse has had limited prior experience with the various cultural groups that are served by the hospital. What might be this nurses greatest challenge?

1. Prejudice

2. Stereotyping

3. Discrimination

4. Assimilation

Correct Answer: 4

Rationale 1: Prejudice is a negative belief or preference that is generalized about a group and leads to prejudging.

Rationale 2: Stereotyping is assuming that all members of a culture or ethnic group are alike.

Rationale 3: Discrimination occurs when a person acts on prejudice and denies another person one or more of the fundamental rights.

Rationale 4: Assimilation is the process by which an individual develops a new cultural identity. Assimilation means becoming like the members of the dominant culture. Because this is a conscious effort, it is not always possible, and the process may cause severe stress and anxiety.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8. Create self-awareness of your own culture, beliefs, biases, and assumptions.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 279

Question 7

Type: MCSA

A client has requested that she have a special item present in her room and explains that it gives her a feeling of comfort and a sense of organization. On which psychosocial component is this client focusing?

1. Culture

2. Religion

3. Ethnicity

4. Socialization

Correct Answer: 2

Rationale 1: Culture is a learned behavior and depends on underlying societal traits, including knowledge, beliefs, art, law, morals, and customs.

Rationale 2: Religion may be defined by a system of beliefs, practices, and ethical values about divine or superhuman power and is closely related to ethnicity. Religion gives a person a frame of reference and a perspective with which to organize information.

Rationale 3: Ethnicity describes the traits and common religious customs and language of a group within the social system.

Rationale 4: Socialization is the process of being raised within a culture and acquiring the characteristics of that group.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe concepts related to culture such as race, ethnicity, and acculturation.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 277

Question 8

Type: MCSA

Before a client goes to surgery, he requests to have his spiritual leader present and pray over him. According to the HEALTH traditions model, which traditional method is the client invoking?

1. Maintaining HEALTH

2. Protecting HEALTH

3. Restoring HEALTH

4. Changing HEALTH

Correct Answer: 3

Rationale 1: Methods of maintaining HEALTH include following a proper diet, wearing proper clothing, concentrating and using the mind, and practicing ones religion.

Rationale 2: Traditional methods of protecting HEALTH include wearing protective objects such as amulets, avoiding people who may cause trouble, and placing religious objects in the home.

Rationale 3: Traditional methods of restoring HEALTHphysical, mental, and spiritualinclude the use of herbal remedies, exorcism, and health rituals. This situation describes a healing ritual.

Rationale 4: Changing HEALTH is not one of the traditional methods in the HEALTH traditions model.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Describe health views from culturally diverse perspectives.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 281

Question 9

Type: MCSA

A client makes the following statement: I must be paying for all the wrongs I did in my life, to have such a diagnosis as this. The nurse suspects that this client views health from which type of belief?

1. Magico-religious belief

2. Holistic health belief

3. Biomedical health belief

4. Folk medicine

Correct Answer: 1

Rationale 1: In the magico-religious health belief view, health and illness are controlled by supernatural forces. The client may believe that illness is the result of being bad or opposing Gods will.

Rationale 2: The holistic health belief holds that the forces of nature must be maintained in balance or harmony. Human life is one aspect of nature that must be in harmony with the rest of nature.

Rationale 3: Biomedical health belief, also termed scientific belief, is based on the belief that life and life processes are controlled by physical and biochemical processes that can be manipulated by humans.

Rationale 4: Folk medicine is defined as those beliefs and practices related to illness prevention and healing that derive from cultural traditions rather than from modern medicines scientific base.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Describe health views from culturally diverse perspectives.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 282

Question 10

Type: MCSA

A Chinese client is hospitalized with a fever of unknown origin and follows a very traditional, cultural view of illness. Which food should the nurse offer the client?

1. Hot tea

2. Warm soup

3. Spicy meat

4. Cold liquids

Correct Answer: 4

Rationale 1: In this case, the fever would be considered a hot illness and the client is not likely to select this treatment.

Rationale 2: In this case, the fever would be considered a hot illness and the client is not likely to select this treatment.

Rationale 3: In this case, the fever would be considered a hot illness and the client is not likely to select this treatment.

Rationale 4: The concept of yin and yang in the Chinese culture is an example of a holistic health belief. A Chinese client who has a yang illness, or a hot illness, may prefer a yin or cold treatment. In this case, the fever would be considered a hot illness and the client may prefer the opposite or yin treatment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 282

Question 11

Type: MCSA

A community health nurse works with a variety of cultures providing health care services that include preventive care, acute treatment, and education. Of the following clients, which is most likely to use folk medicine?

1. The client who speaks little English and does not have a job

2. A family who has numerous relatives in a Spanish-American sector of the city

3. A female client whose culture is one of male dominance

4. A Chinese client who has a small, familyrun business in the area

Correct Answer: 1

Rationale 1: Folk medicine is defined as beliefs and practices that relate illness prevention and healing to cultural traditions rather than modern medicines scientific base. People who have limited access to scientific health care may turn to folk medicine or folk healing. Because folk healing is more culturally based, it may be more comfortable and less frightening for the client who is not fluent in the English language and has limited access to scientific health care.

Rationale 2: There is no evidence to suggest that this family would prefer to use folk medicine.

Rationale 3: There is no evidence to suggest that this client would prefer to use folk medicine.

Rationale 4: There is no evidence to suggest that this client would prefer to use folk medicine.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 282

Question 12

Type: MCSA

A female client is being discharged after a lengthy hospitalization. The family is from a male-dominated culture. Before discharge instructions are given, which action should the nurse take?

1. Make sure instructions are understood by the client.

2. Arrange for teaching when the spouse is available.

3. Make sure that the physician gives the instructions.

4. Ask the client when the best time for teaching would be.

Correct Answer: 2

Rationale 1: Regardless of cultural considerations, its always necessary to make sure that the instructions are understood.

Rationale 2: The nurse needs to identify who has the authority to make decisions in a clients family. If the decision maker is someone other than the client, as in this situation, the nurse needs to include that person in health care discussions. In this situation, we do not know if the nurse is male or female, so the best answer given with the information that is known is to arrange for teaching when the spouse is available.

Rationale 3: This will not address the cultural issue of male dominance.

Rationale 4: This will not address the issue of male dominance.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 283

Question 13

Type: MCSA

A newly immigrated client is constantly attended to by family members. This has presented a problem to the nursing staff and the delivery of nursing care. In order to address this issue in a culturally sensitive manner, the nurse should take which action?

1. Explain to the client that he has to limit visitors.

2. Evaluate the benefits of family participation in the clients care.

3. Question the family members as to how they see their interaction with the client.

4. Have the physician limit the number of visitors the client can have.

Correct Answer: 2

Rationale 1: Telling the client he has to limit visitors or having the physician do this may be in conflict with cultural values and is not helpful to the client.

Rationale 2: Cultural family values may dictate the extent of the familys involvement in the hospitalized clients care. In some cultures, the entire community may want to visit and participate in the clients care. The nurse should evaluate the positive benefits of family participation in the clients care and modify visiting policies as appropriate.

Rationale 3: It would be more appropriate to question the client, not the family members, about the positive benefits of the family interactions because the family members are obviously supportive of their presence.

Rationale 4: This is a nursing issue and should be managed by the nurse.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 283

Question 14

Type: MCSA

The nurse is planning to conduct a physical assessment with a client from a different culture. What is the best way for the nurse to show cultural sensitivity when addressing the personal questions required of the nursing history?

1. Break the assessment into shorter intervals and discuss general topics first.

2. Thoroughly explain the reason for asking many questions before beginning the assessment.

3. Pick a time when the family is present and can help with the admission assessment questions.

4. Wait until the nurseclient relationship has been established.

Correct Answer: 1

Rationale 1: Clients may be offended when the nurse immediately asks personal questions. In some cultures, courtesies should be established before business or personal topics are discussed. Discussing general topics can convey that the nurse is interested and has time for the client. This enables the nurse to develop a rapport with the client before progressing to discussion that is more personal.

Rationale 2: Even if the explanation is given, clients from some cultures may still find questions of a personal nature offensive so early in the nurseclient association.

Rationale 3: The sensitive issue is not necessarily one of language or communication barriers.

Rationale 4: Waiting to complete the assessment is not a good idea as there is certain, initial information that needs to be collected from the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9. Identify methods of cultural assessment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 284

Question 15

Type: MCSA

A non-Englishspeaking client is needs to have an emergency surgical procedure. The hospital has an interpreter available. When the interpreter arrives to explain the procedure and help with the consent form, the nurse provides the best support when

1. asking the interpreter to use words the client is familiar with for the best understanding.

2. requesting that the interpreter translate, as closely as possible, the same words used by the professional staff.

3. suggesting that the questions be directed to the interpreter, so nothing is omitted.

4. addressing the questions to the clients family.

Correct Answer: 2

Rationale 1: The objective of the professional interpreter is for the complete transfer of the thought behind the utterance in one language into an utterance in a second language.

Rationale 2: An interpreter is an individual who mediates spoken or signed communication between people using different languages without adding, omitting, or distorting meaning or editorializing. The objective of the professional interpreter is for the complete transfer of the thought behind the utterance in one language into an utterance in a second language.

Rationale 3: The questions should be addressed to the client, not the interpreter.

Rationale 4: The questions should be addressed to the client, not the family, unless the client is incapable of answering.

Global Rationale: Page Reference:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Describe ways culture influences communication patterns and how to provide linguistically appropriate care.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 284

Question 16

Type: MCSA

During the admission interview, the culturally diverse client averts her eyes and refrains from answering questions for long periods of time. The culturally sensitive nurse should take which action?

1. Come back at a different time, when the client is feeling more communicative.

2. Have another nurse finish the interview, as there is something uncomfortable the client senses.

3. Understand that this may be completely appropriate and take cues accordingly.

4. Leave the room and come back after having learned more about this particular culture.

Correct Answer: 3

Rationale 1: The nursing interview is the nurses responsibility and should not be postponed for what the nurse perceives as the clients reluctance to communicate.

Rationale 2: The nurse is responsible for the admission interview and it should not be avoided for reasons of discomfort.

Rationale 3: Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. Some cultures are quite comfortable with long periods of silence. Many people value silence and view it as essential to understanding a persons needs or use silence to preserve privacy. Before assigning meaning to nonverbal behavior, the nurse must consider the possibility that the behavior may have a different meaning for the client and family.

Rationale 4: The admission history can not be postponed in order for the nurse to improve his or her cultural awareness.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Describe ways culture influences communication patterns and how to provide linguistically appropriate care.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 285

Question 17

Type: MCSA

The school nurse is conducting head lice screenings. Before checking the head of an Asian child, the nurse should first take which action?

1. Ask permission.

2. Make sure the child understands the reason for the contact.

3. Put gloves on.

4. Ask the child to wait until last, to avoid embarrassing the child.

Correct Answer: 1

Rationale 1: In some Asian cultures, only certain elders are permitted to touch the head of others, and children are never patted on the head. Nurses should, therefore, touch a clients head only with permission.

Rationale 2: The nurse should explain the reason for the touching to all children.

Rationale 3: Nurses should always wear gloves for this type of screening process.

Rationale 4: Asking the child to wait until last to avoid embarrassment is not appropriate and does not address the cultural issue.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 286

Question 18

Type: MCSA

The nurse needs to determine the apical pulse of a client from a different culture. In order to show appropriate sensitivity to the client, the nurse should take which action?

1. Explain the procedure, then wait for permission to continue.

2. Explain to the client what will occur during the assessment.

3. Ask the client to stay quiet because the nurse will be listening to the heart.

4. Take the baseline vital signs, then determine if cardiac auscultation is necessary.

Correct Answer: 1

Rationale 1: Cardiac assessment requires that the nurse move into the clients intimate space. Before beginning this, the nurse should explain the procedure and then await permission to continue.

Rationale 2: Explaining the assessment only while performing the procedure and not before is likely to cause the client anxiety and thus negatively affect the assessment values.

Rationale 3: This option is not addressing the sensitivity issues appropriate for this scenario.

Rationale 4: This option is not addressing the sensitivity issues appropriate for this scenario.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 286

Question 19

Type: MCSA

The nurse is teaching a client from a culture that is present oriented about a dressing change that should be performed twice a day. How should the nurse address the cultural issue?

1. Allow the client to select the times the dressing will be changed.

2. Instruct the client to change the dressing after breakfast and before going to bed.

3. Explain that the client should complete the dressing change at 10 AM and 4 PM.

4. Suggest that the dressing change can be performed whenever the client chooses, as long as it gets done twice daily.

Correct Answer: 2

Rationale 1: This option does not assure the dressing changes will occur as prescribed.

Rationale 2: For clients who are present oriented, it is important to avoid fixed schedules. The nurse can offer a time range for activities and treatments, such as in the morning or after breakfast, and in the evening or before going to bed. This would fit better with the client who isnt focused on times of the day, such as 10 AM and 4 PM, but will provide for a dressing change twice daily.

Rationale 3: This option is not likely to be followed by a client who is present oriented.

Rationale 4: This option does not comply with the intended order for the dressing changes.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 286

Question 20

Type: MCSA

The nurse is preparing a menu for a Jewish client who observes kosher customs. Which food items would be appropriate to serve this client, assuming all have been properly inspected and prepared?

1. Hamburger, fruit, and milk

2. Fish, vegetables, and hot tea

3. Ham, baked potato, and fresh fruit

4. Cream soup, sausage, and toast

Correct Answer: 2

Rationale 1: The eating of milk products and meat products at the same meal is prohibited.

Rationale 2: This menu is in accordance with the kosher tradition because there is no pork being served and dairy and meat are not served together.

Rationale 3: Orthodox Judaism and Islam prohibit the ingestion of pork or pork products (ham and sausage).

Rationale 4: The eating of milk products and meat products at the same meal is prohibited.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Differentiate culturally influenced approaches to healing and treatment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 287

.

Question 21

Type: MCSA

The nurse is working in a clinic setting and is meeting a new client for the first time. In order to convey cultural sensitivity, how should the nurse introduce herself?

1. Im Jane, and Ill be your nurse today.

2. Im Dr. Smiths nurse, Jane.

3. Im Jane Brown, and Im a nurse here at the clinic.

4. Im glad to meet you. You can call me Jane.

Correct Answer: 3

Rationale 1: The appropriate introduction should include introducing themselves by full name, then explaining their role. This helps establish a relationship and provides an opportunity for clients, others, and nurses to learn the pronunciation of one anothers names and their roles. This option does not fulfill these requirements.

Rationale 2: The appropriate introduction should include introducing themselves by full name, then explaining their role. This helps establish a relationship and provides an opportunity for clients, others, and nurses to learn the pronunciation of one anothers names and their roles. This option does not fulfill these requirements.

Rationale 3: Ways for nurses to be culturally sensitive and to convey sensitivity to clients include introducing themselves by full name, then explaining their role. This helps establish a relationship and provides an opportunity for clients, others, and nurses to learn the pronunciation of one anothers names and their roles.

Rationale 4: The appropriate introduction should include introducing themselves by full name, then explaining their role. This helps establish a relationship and provides an opportunity for clients, others, and nurses to learn the pronunciation of one anothers names and their roles. This option does not fulfill these requirements.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Describe ways culture influences communication patterns and how to provide linguistically appropriate care.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 288

Question 22

Type: MCSA

A home health client participates in cultural health practices that the nurse feels may be detrimental to his health. In order to remain attentive to cultural sensitivity and provide appropriate cultural nursing care, the nurse should take which action?

1. Explain the right and wrong of the clients treatment and try to persuade him to follow the scientific perspective.

2. Have the clients physician explain the care to the client in a firm but gentle manner.

3. Validate the clients practices and understand that for this client, it may be beneficial to continue with his preferences.

4. Try to negotiate with the client by exploring his views and then provide relevant scientific information.

Correct Answer: 4

Rationale 1: Right and wrong terms should be avoided in culturally sensitive areas and where differing views are present.

Rationale 2: The nurse, not the physician, is the caregiver in this situation, so it is the nurses responsibility to teach and see that the plan of care is carried out.

Rationale 3: If the clients views can lead to harmful behavior or outcomes, then an attempt is made to shift the clients perspectives to the scientific view.

Rationale 4: Negotiation acknowledges that the nurseclient relationship is reciprocal and that different views exist of health, illness, and treatment. During the negotiation process, the clients views are explored and acknowledged, then relevant scientific information is provided.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10. Create a culturally responsive nursing care plan.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 290

Question 23

Type: MCSA

A client who is from a different culture than the nurse has not been able to achieve this goal: Client will select low-fat foods from a list by the end of the month. What should the nurse do?

1. Consider whether the clients belief system has been an influencing factor.

2. Extend the time frame and give the client a longer period to achieve the goal.

3. Make sure that the client understands the importance of the goal.

4. Select a different goal.

Correct Answer: 1

Rationale 1: If the outcomes are not achieved for a client from a different culture, the nurse should be especially careful to consider whether the clients belief system has been adequately included as an influencing factor.

Rationale 2: Extending the time frame may not be as helpful as looking at the cultural practicesincluding dietary onesof the client.

Rationale 3: Checking how the client understands the importance of the goal may not be as helpful as looking at the cultural practicesincluding dietary onesof the client.

Rationale 4: Selecting a different goal may not be as helpful as looking at the cultural practicesincluding dietary onesof the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10. Create a culturally responsive nursing care plan.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 291

Question 24

Type: MCSA

A nurse educator uses Madeleine Leiningers model and describes a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people. What type of nursing is the educator practicing?

1. Transcultural nursing

2. Cultural competence

3. Cultural knowledge

4. Competent nursing

Correct Answer: 1

Rationale 1: Transcultural nursing focuses on providing care within the differences and similarities of the beliefs, values, and patterns of cultures.

Rationale 2: Cultural competence is a life-long process in which the nurse continuously strives to achieve the ability and availability to effectively work within the cultural context of a client (individual, family, community).

Rationale 3: Cultural knowledge reflects the presences of a sound educational foundation concerning the various worldviews of different cultures.

Rationale 4: Transcultural nursing is a component of competent nursing.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Describe cultural models of care, such as cultural competency.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 280

Question 25

Type: MCMA

The community health nurse is using the Heritage Assessment Interview tool with a group of community members. Which data indicate heritage consistent?

Standard Text: Select all that apply.

1. A client frequently visits the old country neighborhood he grew up in.

2. A client is raised by a single parent.

3. The clients education occurred at a religious school.

4. The client participates in religious festivals and cultural events.

5. The client has been the first of his family to earn a college degree.

Correct Answer: 1, 3, 4

Rationale 1: The tool is designed to enhance the process of determining whether clients are identifying with their traditional cultural heritage (heritage consistent), such as by visiting an ethic neighborhood.

Rationale 2: The tool is not designed to assess such nonculturally oriented events.

Rationale 3: The tool is designed to enhance the process of determining whether clients are identifying with their traditional cultural heritage (heritage consistent), such as by attending a religiously affiliated school.

Rationale 4: The tool is designed to enhance the process of determining whether clients are identifying with their traditional cultural heritage (heritage consistent), such as by attending and participating in religious and cultural events.

Rationale 5: The tool is not designed to assess such nonculturally oriented events.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9. Identify methods of cultural assessment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 288

Question 26

Type: MCMA

The nurse is planning to provide culturally responsive care to a minority client and family. What actions should the nurse perform when providing this care?

Standard Text: Select all that apply.

1. Personally reflecting on feelings related to the clients nationality

2. Making an effort to direct all assessment questions initially to the client

3. Involving the family with the clients permission

4. Assessing the clients interest in alternative healing methods

5. Educating the client and family when appropriate

Correct Answer: 1, 3, 4, 5

Rationale 1: Culturally responsive care that involves family appropriately includes selfreflection to identify your personal assumptions, biases, attitudes, prejudices, and stereotypes.

Rationale 2: Determine the cultural expectations related to the hierarchy of the family.

Rationale 3: Culturally responsive care that involves family appropriately includes explaining in detail the clients condition and the treatment plan with the family if the client is willing for the nurse to do so.

Rationale 4: Culturally responsive care that involves family appropriately includes asking about the clients use of cultural or alternative approaches to healing.

Rationale 5: Culturally responsive care that involves family appropriately includes explaining in detail the clients condition and treatment plan with the family if the client is willing for the nurse to do so.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9. Identify methods of cultural assessment.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 288

Question 27

Type: MCMA

The nurse is planning to explain the importance of culturally appropriate care to a new nursing assistant. What should the nurse include when explaining the term culture to this staff person?

Standard Text: Select all that apply.

1. Culture involves groups who share biological markers.

2. Cultures seldom have diversity within them.

3. Male nurses are an example of a culture.

4. A culture is primarily exhibited through shared thoughts, actions, and beliefs.

5. A culture shapes its members view of the world.

Correct Answer: 4, 5

Rationale 1: Race has been a term used to refer to groupings of people according to common origin or background and associated with perceived biological markers.

Rationale 2: Diversity occurs not only between cultural groups but also within cultural groups.

Rationale 3: A subculture is usually composed of people who have a distinct identity and yet are related to a larger cultural group.

Rationale 4: Culture is the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

Rationale 5: Macro- and micro-cultures combine to shape the individuals worldview and influence interaction with the others.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a persons development

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe concepts related to culture such as race, ethnicity, and acculturation.

MNL Learning Outcome: 1.3.3. Consider cultural and spiritual aspects that influence nursing care.

Page Number: 276

New Questions:

Question 28

Type: MCMA

After an assessment, the nurse determines that a client of African American descent is experiencing disparities that are a part of behavioral health determinants. What assessment data did the nurse use to come to this conclusion?

Standard Text: Select all that apply.

 

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