Chapter 4 My Nursing Test Banks

DAmico/Barbarito Health & Physical Assessment in Nursing, 2/e
Chapter 4

Question 1

Type: MCSA

The nurse is preparing an educational program for the staff on cultural considerations. The nurse includes the following definition: The adoption and incorporation of characteristics, customs, and values of the dominant culture by those new to that culture. The nurse is referring to which of the following terms?

1. Ethnicity

2. Assimilation

3. Ethnocentrism

4. Culture

Correct Answer: 2

Rationale 1: Ethnicity is the awareness of belonging to a group in which certain characteristics or aspects of a culture, such as biology, differentiate the members of one group from another.

Rationale 2: Assimilation matches the definition described.

Rationale 3: Ethnocentrism is the tendency to believe that ones own beliefs, way of life, values, and customs are superior to those of others.

Rationale 4: Culture is the nonphysical traits, such as values, beliefs, attitudes, and customs that are shared by a group of people and passed from one generation to another.

Global Rationale: Assimilation matches the definition described. Ethnicity is the awareness of belonging to a group in which certain characteristics or aspects of a culture, such as biology, differentiate the members of one group from another. Ethnocentrism is the tendency to believe that ones own beliefs, way of life, values, and customs are superior to those of others. Culture is the nonphysical traits, such as values, beliefs, attitudes, and customs that are shared by a group of people and passed from one generation to another.

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.1: Define culture.

Question 2

Type: MCSA

The nurse is admitting a client of the Muslim faith during the holy month of Ramadan. The client tells the nurse that he must fast during this time. Which of the following would be an appropriate response by the nurse?

1. What can we do to accommodate your needs during your stay here?

2. I will let your doctor know so he can discharge you.

3. Fasting is harmful to your body.

4. You must have food during times of illness.

Correct Answer: 1

Rationale 1: Some people will report adhering to a particular faith but will not strictly adhere to certain practices. Further assessment is needed to determine this clients beliefs, desire to adhere to the practice, and extent to which the practice may be altered considering the illness and hospitalization. Making certain assumptions without further assessment would result in actions not respectful of or beneficial to the client.

Rationale 2: Making assumptions such as the healthcare provider discharging this client without further assessment would result in actions not respectful of or beneficial to the client.

Rationale 3: Making assumptions such as fasting being bad for the body without further assessment would result in actions not respectful of or beneficial to the client.

Rationale 4: Making assumptions such as the client being unable to fast during illness without further assessment would result in actions not respectful of or beneficial to the client.

Global Rationale: Many faiths describe circumstances in which fasts may be altered or eliminated during times of illness and hospitalization. Additionally, some people will report adhering to a particular faith but will not strictly adhere to certain practices. Further assessment is needed to determine this clients beliefs, desire to adhere to the practice, and extent to which the practice may be altered considering the illness and hospitalization. Making certain assumptions without further assessment would result in actions not respectful of or beneficial to the client.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 3

Type: MCSA

The nurse is caring for an elderly Native American client who is experiencing severe chest pain. A tribesman has accompanied him to the hospital at the insistence of the client. The tribesman tells the nurse that their culture teaches acceptance of death as part of the natural cycle of life and that treatments must be stopped. The clients son insists that his father be treated, and states he feels the tribes teachings are antiquated. What is the best action for the nurse to take in this situation?

1. Call the social worker to plan a family meeting without the tribesman.

2. Interview the client and ascertain his wishes and beliefs.

3. Convene the hospital ethics committee.

4. Call the nursing supervisor.

Correct Answer: 2

Rationale 1: It would be inappropriate to call a family meeting, with or without an interested second party, if the client is competent and has not asked for such a meeting.

Rationale 2: The client is an adult and, if capable of expressing his wishes and beliefs, should be encouraged to do so. Sometimes the client must be interviewed alone to be sure the client is actually stating his own wishes and not those of family members who may be present for the interview. Unless an adult is not competent to make and express his own decisions, or is impaired in some way and cannot express his own wishes, then the adult clients wishes are honored over all others who may try to exert influence.

Rationale 3: At this time, there is not enough data to ask the hospital ethics committee to render an opinion.

Rationale 4: There is at the moment no behavior exhibited that would warrant notifying hospital administration.

Global Rationale: The client is an adult and if capable of expressing his wishes and beliefs, should be encouraged to do so. Sometimes the client must be interviewed alone to be sure the client is actually stating his own wishes and not those of family members who may be present for the interview. Unless an adult is not competent to make and express his own decisions, or is impaired in some way and cannot express his own wishes, then the adult clients wishes are honored over all others who may try to exert influence. It would be inappropriate to call a family meeting, with or without an interested second party, if the client is competent and has not asked for such a meeting. There is at the moment no behavior exhibited that would warrant notifying hospital administration, nor is there enough data to ask the hospital ethics committee to render an opinion.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 4

Type: MCSA

The nurse is assessing a 16-year-old male. The individual is fluent in English, participates in high school sports, values riding his dirt bike, and plans to go to college after graduating from high school. The clients health history indicates the he was born in China and came to the United States at age 4. When asked where he is from, he says the United States. The nurse understands that his behaviors and statements indicate that:

1. He has no interest in the interview.

2. He is embarrassed about his ethnicity.

3. He is assimilated into the American culture.

4. He wishes to deny his Asian heritage.

Correct Answer: 3

Rationale 1: There is no evidence that this client is bored with the interview.

Rationale 2: There is no evidence that this client is embarrassed.

Rationale 3: The teens answers indicate characteristics and behaviors of the American culture.

Rationale 4: There is no evidence that this client wishes to deny Asian heritage.

Global Rationale: The teens answers indicate characteristics and behaviors of the American culture. Often, those who have not assimilated are not fluent in the language of the new culture and do not display certain behaviors and characteristics of the new culture. There is no evidence to support other assumptions, such as that he wishes to deny his heritage, that he is embarrassed about his appearance, or that he is bored with the interview.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 5

Type: MCMA

The nurse manager is discussing cultural considerations with a group of student nurses. Which of the statements by the nursing students indicates a lack of understanding about cultural concepts?

Standard Text: Select all that apply.

1. Culture can best be described as an awareness of belonging to a group in which certain characteristics differentiate the members of one group from another.

2. A good description of culture is one that recognizes its the socially transmitted beliefs, behaviors, values, customs, lifestyles and ways of thinking of a specific population that guides an individuals worldview.

3. Culture is the belief that ones own beliefs, way of life, values, and customs are superior to others.

4. Culture is the identification of an individual or group by shared genetic heritage and biologic characteristics.

5. Decisions made by an individual are largely influenced by culture.

Correct Answer: 3,4

Rationale 1: Culture can best be described as an awareness of belonging to a group in which certain characteristics differentiate the members of one group from another. Ethnicity is the awareness of belonging to a group in which certain characteristics differentiate the members of one group from another.

Rationale 2: A good description of culture is one that recognizes its the socially transmitted beliefs, behaviors, values, customs, lifestyles and ways of thinking of a specific population that guides an individuals worldview. Culture is the socially transmitted beliefs, behaviors, values, customs, lifestyles, and ways of thinking of a specific population that guides worldview and decision-making.

Rationale 3: Culture is the belief that ones own beliefs, way of life, values, and customs are superior to others. Ethnocentrism is the tendency to believe that ones own beliefs, way of life, values, and customs are superior to others.

Rationale 4: Culture is the identification of an individual or group by shared genetic heritage and biologic characteristics. Race is the identification of an individual or group by shared genetic heritage and biologic or physical characteristics.

Rationale 5: Decisions made by an individual are largely influenced by culture. Decision making is guided by ones beliefs, values, customs and way of thinking, which is culture.

Global Rationale: Ethnicity is the awareness of belonging to a group in which certain characteristics differentiate the members of one group from another. Culture is the socially transmitted beliefs, behaviors, values, customs, lifestyles, and ways of thinking of a specific population that guides worldview and decision making. Ethnocentrism is the tendency to believe that ones own beliefs, way of life, values, and customs are superior to others. Race is the identification of an individual or group by shared genetic heritage and biologic or physical characteristics. Decision making is guided by ones beliefs, values, customs and way of thinking, which is culture.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.1: Define culture.

Question 6

Type: MCSA

The nurse is completing a self-assessment to determine cultural competence. The nurse would identify which of the following behaviors as part of being culturally competent?

1. Obtaining a ham sandwich for a Jewish client admitted to the hospital unit after trays have been delivered

2. Referring to the Asian client as an Oriental

3. Permitting a Bedouin to sleep on the floor

4. Advising a Catholic client that being taken to the chapel for noon Mass is impossible because lunch times have been assigned

Correct Answer: 3

Rationale 1: Jewish persons do not eat pork.

Rationale 2: Referring to an Asian as an Oriental is offensive.

Rationale 3: Bedouin immigrants from Arabia are nomads who are used to sleeping on the ground.

Rationale 4: Attending Mass is an obligation of Catholics and takes priority over lunchtime assignments, which can be revised.

Global Rationale: Bedouin immigrants from Arabia are nomads who are used to sleeping on the ground. Attending Mass is an obligation of Catholics and takes priority over lunchtime assignments, which can be revised. Jewish persons do not eat pork. Referring to an Asian as an Oriental is offensive.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4.2: Identify terms related to culture.

Question 7

Type: MCMA

The nurse is studying matriarchal cultures and needs to complete a report on how this aspect affects health care within the culture. The nurse identifies which of the following groups as most likely to be patriarchal?

Standard Text: Select all that apply.

1. Appalachian

2. American Indian

3. African American

4. Italian

5. Arab American

Correct Answer: 1,4,5

Rationale 1: Appalachian. Patriarchal groups are those that are largely headed by a male family figure. Appalachian families are most likely to be patriarchal.

Rationale 2: American Indian. Native American cultures are matrilineal with grandmothers and mothers being most important.

Rationale 3: African American. Patriarchal groups are those that are largely headed by a male family figure. African American groups are most likely to be matriarchal.

Rationale 4: Italian. Patriarchal groups are those that are largely headed by a male family figure. Italian groups are most likely to be patriarchal.

Rationale 5: Arab American. Patriarchal groups are those who are largely headed by a male family figure. Arab American groups are most likely to be patriarchal.

Global Rationale: Patriarchal groups are those who are largely headed by a male family figure. Appalachian families, Italian families, and Arab American families are most likely to be patriarchal. Native American and African American families are most likely to be matriarchal, or lead by a female member of the family.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.2: Identify terms related to culture.

Question 8

Type: MCMA

The nurse is interviewing a client and wishes to determine the roles of various members of an extended family living together in one household. Which of the following statements would be helpful for the nurse to use to obtain this information?

Standard Text: Select all that apply.

1. What language is spoken in your house?

2. Are all of your family members working?

3. Tell me about the responsibilities of family members in your home.

4. Who makes the decisions for your family members?

5. Are you happy with your place in the family?

Correct Answer: 3,4

Rationale 1: What language is spoken in your house? The language spoken in the home will not help in the identification of roles within the household members.

Rationale 2: Are all of your family members working? Open-ended questions are needed to obtain the most accurate and comprehensive information. This question is closed and would provide the nurse with little information other than a yes or no response.

Rationale 3: Tell me about the responsibilities of family members in your home. The responsibilities of the family members will allow the nurse to hear the various roles each of them holds.

Rationale 4: Who makes the decisions for your family members? Identification of decision-making roles will aid the nurse in determining roles of the members.

Rationale 5: Are you happy with your place in the family? Closed questions will do little to obtain information from the client. Happiness will not reflect roles of family members.

Global Rationale: The language spoken in the home will not help in the identification of roles within the household members. Open-ended questions are needed to obtain the most accurate and comprehensive information. The responsibilities of the family members will allow the nurse to hear the various roles each of them holds. Identification of decision-making roles will aid the nurse in determining roles of the members. Asking if all of the family members are working and if the client is happy with his or her place in the family are closed questions and would provide the nurse with little information other than a yes or no response.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 9

Type: MCSA

The nurse manager is preparing for an accreditation visit and wants to assure that the unit is delivering culturally appropriate health care. Which of the following would demonstrate this approach by the nurse manager?

1. Insisting the staff teaches clients English during their hospitalization.

2. Examining the process used to admit clients.

3. Providing written materials in languages spoken most commonly by clients admitted to the unit.

4. Limiting education and training to the bedside nurses.

Correct Answer: 3

Rationale 1: Requiring English be taught to clients admitted to the hospital does not promote the value of other cultures and promotes a sense of ethnocentrism.

Rationale 2: The process used to admit clients may be included in the road to accreditation but does not directly address the delivery of culturally responsible care.

Rationale 3: The National Standards for Culturally and Linguistically Appropriate Services in Healthcare outlines 14 valid approaches for health care to assure that cultural competency is provided.

Rationale 4: Nurses at the bedside require education to maintain competency and learn new skills.

Global Rationale: The National Standards for Culturally and Linguistically Appropriate Services in Healthcare outlines 14 valid approaches for health care to assure that cultural competency is provided. Requiring English be taught to clients admitted to the hospital does not promote the value of other cultures and promotes a sense of ethnocentrism. The process used to admit clients may be included in the road to accreditation but does not directly address the delivery of culturally responsible care. Nurses at the bedside require education to maintain competency and learn new skills.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 10

Type: MCSA

The nurse is interviewing a client and wishes to determine health practices that are important to the clients beliefs. Which of the following statements would be appropriate for the nurse to use to obtain this information?

1. Do you use any nontraditional medicine?

2. Tell me what you do to try to improve your health.

3. How many times have you been sick in your life?

4. Do you have medical insurance?

Correct Answer: 2

Rationale 1: Asking about nontraditional medicine practices is too focused for the data the nurse is seeking.

Rationale 2: The nurse should use open-ended questions when interviewing clients. This choice provides direction for the client, but allows verbalization of information to clarify health beliefs for the nurse.

Rationale 3: Asking about how many times the client has been ill over a lifetime is too focused for the data the nurse is seeking.

Rationale 4: Asking about whether the client has medical insurance is too focused for the data the nurse is seeking.

Global Rationale: The nurse should use open-ended questions when interviewing clients. This choice provides direction for the client, but allows verbalization of information to clarify health beliefs for the nurse. Asking about nontraditional medicine practices, how many times the client has been ill over a lifetime, and whether the client has medical insurance are too focused for the data the nurse is seeking.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups

Question 11

Type: MCSA

The nurse is caring for a client who insists on having food very hot and very cold at each meal. The nurse correctly recognizes this as a health belief in which of the following cultural groups?

1. Cuban Americans

2. Jewish Americans

3. Chinese Americans

4. Native Americans

Correct Answer: 3

Rationale 1: The belief in yin and yang supports the request for the two temperature variations in the clients meals. Cuban Americans do not support this practice.

Rationale 2: The belief in yin and yang supports the request for the two temperature variations in the clients meals. Jewish Americans do not support this practice.

Rationale 3: Chinese Americans believe that health is maintained by the balance of two forces, yin and yang. This belief supports the request for the two temperature variations in the clients meals.

Rationale 4: The belief in yin and yang supports the request for the two temperature variations in the clients meals. Native Americans do not support this practice.

Global Rationale: Chinese Americans believe that health is maintained by the balance of two forces, yin and yang. This belief supports the request for the two temperature variations in the clients meals. None of the other choices (Cuban Americans, Jewish Americans, Native Americans) support this practice.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 12

Type: MCSA

The female nurse is examining a Vietnamese male and notes that he will not make eye contact with her during the assessment. The client appears very uncomfortable and is sweating and flushed. Which of the following actions would be appropriate for the nurse in this situation?

1. Obtain a blood sugar reading.

2. Ask the client if he would like a male to perform the examination.

3. Assure the client that the exam will be over quickly.

4. Continue with the examination.

Correct Answer: 2

Rationale 1: Continuing the delivery of care by obtaining a blood sugar reading is inappropriate as it does not address the clients feelings of discomfort.

Rationale 2: The Vietnamese culture prefers same-sex health care providers and may be extremely uncomfortable when the nurse does not provide this. The nurse needs to gather additional data by asking the client his preferences and allowing verbalization of his discomfort.

Rationale 3: Continuing the delivery of care by offering reassurance about the examination being over quickly is inappropriate as it does not address the clients feelings of discomfort.

Rationale 4: Continuing the delivery of care by continuing the examination is inappropriate as it does not address the clients feelings of discomfort.

Global Rationale: The Vietnamese culture prefers same-sex health care providers and may be extremely uncomfortable when the nurse does not provide this. The nurse needs to gather additional data by asking the client his preferences and allowing verbalization of his discomfort. Continuing the delivery of care by obtaining a blood sugar reading, offering reassurance about the examination being over quickly, or continuing the examination are all inappropriate as they do not address the clients feelings of discomfort.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 13

Type: MCSA

The nurse is admitting a client and asks to see all medications taken on a routine basis. The client offers a long list containing prescription medications and a variety of herbal preparations that are unfamiliar names to the nurse. Which of the following actions would be appropriate for the nurse at this time?

1. Write down all the names of the herbals and look them up later.

2. Tell the client that herbals are ineffective and to throw them away.

3. Inform the healthcare provider of the herbals.

4. Ask the client what they are taken for and how often.

Correct Answer: 4

Rationale 1: Looking up the herbal preparations will enhance the level of knowledge by the nurse but is not the priority action.

Rationale 2: Asking the client to throw the items away will not address potential impact of their past ingestion.

Rationale 3: This step should be done only after the nurse has completed the assessment as associated with these substances.

Rationale 4: The nurse must assess prior to intervening and must understand that some cultures use herbal preparations in their health practices. The nurse needs to obtain additional data from the client about what the herbals are used for and how often they are taken. This information should be documented in the clients record and thus be available to the healthcare provider.

Global Rationale: The nurse must assess prior to intervening and must understand that some cultures use herbal preparations in their health practices. The nurse needs to obtain additional data from the client about what the herbals are used for and how often they are taken. This information should be documented in the clients record and thus be available to the healthcare provider. It will enhance the level of knowledge by the nurse to look up the herbal preparations but is not the priority action. Asking the client to throw the items away will not address potential impact of their past ingestion. The remaining choices are not appropriate at this time.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 14

Type: MCSA

The nurse is setting up a meal tray. She notes that the client refuses to look at the food and tells the nurse to take it away. The meal contains a chicken breast, green beans, fruit cocktail, and cottage cheese. The nurses most appropriate response to the client at this time is which of the following?

1. I know you are not hungry so just let me know when you want your tray.

2. The hospital food is horrible here.

3. Is there a problem with the food being sent to you?

4. I will get you some juice and crackers from the unit kitchen.

Correct Answer: 3

Rationale 1: While the patient may not be hungry, the nurse must determine if this is indeed the case.

Rationale 2: Telling the patient the food is horrible is inappropriate and does not promote the dietary intake of the client

Rationale 3: The nurse must be alert and aware of cultural preferences related to dietary habits. Further assessment in this situation is needed to obtain data about the clients inability to look at or eat the food.

Rationale 4: Offering other food options may be an option once the underlying cause for the clients refusal is determined. Offering juice and crackers is not appropriate for the situation.

Global Rationale: The nurse must be alert and aware of cultural preferences related to dietary habits. Further assessment in this situation is needed to obtain data about the clients inability to look at or eat the food. While the patient may not be hungry, the nurse must determine if this is indeed the case. Telling the patient the food is horrible is inappropriate and does not promote the dietary intake of the client. Offering other food options may be an option once the underlying cause for the clients refusal is determined. Offering juice and crackers is not appropriate for the situation.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 15

Type: MCMA

When preparing to perform a cultural assessment for a client, the nurse is aware of the numerous components that will aid in the identification of ethnicity. When preparing to ask appropriate questions to assess unique needs, which of the following questions will be beneficial?

Standard Text: Select all that apply.

1. What is your religious preference?

2. Can you identify any food practices that will impact your prescribed plan of care?

3. To what ethnic group do you identify yourself?

4. Does your mother practice the same religion as you?

5. What political party do you belong to?

Correct Answer: 1,2,3

Rationale 1: What is your religious preference? Religious preference determination is a component of the cultural assessment.

Rationale 2: Can you identify any food practices which will impact your prescribed plan of care? Dietary preferences are deeply ingrained into cultural beliefs and preferences. Assessment of dietary restrictions or preferences is a component of the cultural assessment.

Rationale 3: To what ethnic group do you identify yourself? Ethnicity involves both internal and external identification practices. The nurse must ask what the client prefers.

Rationale 4: Does your mother practice the same religion as you? Although families frequently practice the same religion it is not appropriate to make this inquiry.

Rationale 5: What political party do you belong to? Politics are a component of ethnicity but are not a requirement nor an appropriate question for the admission assessment.

Global Rationale: Religious preference determination is a component of the cultural assessment. Dietary preferences are deeply ingrained in cultural beliefs and preferences. Assessment of dietary restrictions or preferences is a component of the cultural assessment. Ethnicity involves both internal and external identification practices. The nurse must ask what the client prefers. Although families frequently practice the same religion it is not appropriate to make this inquiry. Politics are a component of ethnicity but are not a requirement nor an appropriate question for the admission assessment.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.2: Identify terms related to culture.

Question 16

Type: MCSA

While acting as a preceptor for a graduate nurse, the registered nurse notices the graduate nurse voices frustration and a lack of appreciation for the health care beliefs and practices of clients whose beliefs differ from her own. Which of the following actions will best assist the preceptor to improve the graduates practice?

1. The nurse should advise the graduate to reduce displays of frustration and lack of appreciation for the values of others.

2. The nurse should encourage the graduate to look closely at the graduates own cultural practices and beliefs.

3. The graduate should receive a written reprimand.

4. The graduate should be required to meet with a counselor concerning her ethnic biases.

Correct Answer: 2

Rationale 1: Simply reducing the comments and displays of frustration will not address the root cause of the problem. The underlying cause must be handled to resolve the issue.

Rationale 2: Ethnocentrism is the belief of ones personal beliefs to be superior to those held by others. The best manner in which to begin to manage and reduce these feelings is to begin the process of self-awareness.

Rationale 3: Administering a written reprimand will not handle the existing problem. The underlying cause must be handled to resolve the issue.

Rationale 4: Counseling and discipline may be warranted later in the process if the behaviors continue or worsen.

Global Rationale: Ethnocentrism is the belief of ones personal beliefs to be superior to those held by others. The best manner in which to begin to manage and reduce these feelings is to begin the process of self-awareness. Simply reducing the comments and displays of frustration will not address the root cause of the problem. The underlying cause must be handled to resolve the issue. Administering a written reprimand will not handle the existing problem. Counseling and discipline may be warranted later in the process if the behaviors continue or worsen.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 17

Type: MCSA

The nurse is assigned to provide care to a diabetic client who indicated being a Muslim on the admission assessment. When planning the care for the shift, which of the following factors may have the greatest impact on the care?

1. The client has a strong respect for the elders in the family.

2. Pork in the diet is forbidden.

3. The client may practice religious fasting.

4. Lamb and chicken are the main sources of protein.

Correct Answer: 3

Rationale 1: The respect for elders in the family is not a detriment to the successful plan of care.

Rationale 2: The lack of pork in the diet does not hinder dietary planning.

Rationale 3: During special religious events Muslims participate in fasting during the daylight hours. The diabetic client who engages in fasting and the nurse providing care will face unique challenges.

Rationale 4: Lamb and chicken provide adequate, healthful alternatives.

Global Rationale: During special religious events Muslims participate in fasting during the daylight hours. The diabetic client who engages in fasting and the nurse providing care will face unique challenges. The lack of pork in the diet does not hinder dietary planning. Lamb and chicken provide adequate, healthful alternatives. The respect for elders in the family is not a detriment to the successful plan of care.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 18

Type: MCSA

The nurse is charge nurse for the shift. Three of the staff members are female and one is male. Which of the following clients should be assigned to a female staff member?

1. The African American female

2. The African American male

3. The Arab American male

4. The Arab American female

Correct Answer: 4

Rationale 1: The African American female would likely not have difficulty being assigned to the patient load of the male staff nurse.

Rationale 2: The African American male would likely not have difficulty being assigned to the patient load of the male staff nurse.

Rationale 3: The Arab American male would likely not have difficulty being assigned to the patient load of the male staff nurse.

Rationale 4: The teachings and beliefs of Arab Americans restrict physical touch between unmarried males and females.

Global Rationale: The teachings and beliefs of Arab Americans restrict physical touch between unmarried males and females. The African American female and male and the Arab American male would likely not have difficulty being assigned to the patient load of the male staff nurse.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 19

Type: MCSA

When providing an inservice to new graduate nurses, the nurse educator discusses expectations for the nursing staff concerning the acceptance of client cultural beliefs. Which of the following statements by a participant indicates further teaching is needed?

1. The acceptance of different cultural values is needed to provide quality nursing care.

2. Cultural values may dictate my client assignments on the nursing unit.

3. My own cultural values are irrelevant to the acceptance of the values of others.

4. My knowledge of the cultural values of others will increase in time.

Correct Answer: 3

Rationale 1: Failure to have self-awareness can result in ethnocentrism.

Rationale 2: The cultural values and beliefs of the client may require sensitive scheduling.

Rationale 3: The knowledge and acceptance of ones own cultural values is essential to the acceptance and awareness of the values of the client.

Rationale 4: Time does allow the nurse to develop additional knowledge of many issues in nursing, including cultural considerations.

Global Rationale: The knowledge and acceptance of ones own cultural values is essential to the acceptance and awareness of the values of the client. Failure to have self-awareness can result in ethnocentrism. The cultural values and beliefs of the client may require sensitive scheduling. Time does allow the nurse to develop additional knowledge of many issues in nursing, including cultural considerations.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4.3: Describe cultural phenomena that impact healthcare

Question 20

Type: MCSA

The nurse is collecting data concerning the clients chief complaint. The client reports having attempted to manage the illness using herbs. Which of the following responses by the nurse is most therapeutic?

1. What herbs have been used to manage your condition?

2. Does your healthcare provider know about your herbal remedies?

3. Dont you realize your recovery may have been impeded by these herbal preparations?

4. When was the last dosage of the herbal remedies taken?

Correct Answer: 1

Rationale 1: The comprehensive assessment of health requires the nurses to obtain as much information as possible. The nurse will need to determine the herbs in use to ensure there are not adverse interactions between the treatments that may be ordered by the healthcare provider.

Rationale 2: Asking about the healthcare providers knowledge of the remedies and the implications made concerning the potential damage caused by the herbs are presented in closed questions. Further, they may imply to clients that they have engaged in wrongdoing.

Rationale 3: Asking about the healthcare providers knowledge of the remedies and the implications made concerning the potential damage caused by the herbs are presented in closed questions. Further, they may imply clients that they have engaged in wrongdoing.

Rationale 4: The last dosage of the herbal remedies may be beneficial; however, it is not the most therapeutic question to be asked.

Global Rationale: The comprehensive assessment of health requires the nurses to obtain as much information as possible. The nurse will need to determine the herbs in use to ensure there are not adverse interactions between the treatments that may be ordered by the healthcare provider. Asking about the healthcare providers knowledge of the remedies and the implications made concerning the potential damage caused by the herbs are presented in closed questions. Closed questions limit the amount of information obtained. Further, they may imply to the client they have engaged in wrongdoing. The last dosage of the herbal remedies may be beneficial; however, it is not the most therapeutic question to be asked.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 21

Type: MCSA

The nurse is preparing to perform an assessment of the clients social support and organization. Which of the following questions will provide the needed information?

1. Where was the client born?

2. What is the primary language spoken in the family home?

3. What nonverbal communication behaviors are observed during the nurse-client interaction?

4. Is there a religious affiliation linked with the cultural affiliation?

Correct Answer: 4

Rationale 1: Finding out the location of the clients birth provides information concerning ethnicity.

Rationale 2: The primary language spoken in the home is of importance but does not determine the clients social support.

Rationale 3: Communication patterns are identified by the types of nonverbal behaviors observed.

Rationale 4: During the data collection phase, data are collected to determine the social organization of the client. Assessment of religious affiliation / cultural affiliation will provide information concerning the social organization of the client.

Global Rationale: During the data collection phase, data are collected to determine the social organization of the client. Assessment of religious affiliation / cultural affiliation will provide information concerning the social organization of the client. Finding out the location of the clients birth provides information concerning ethnicity. The primary language spoken in the home is of importance but does not determine the clients social support. Communication patterns are identified by the types of nonverbal behaviors observed.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.2: Identify terms related to culture. Identify terms related to culture.

Question 22

Type: MCSA

While working in an ambulatory care clinic, a Hispanic client who speaks limited English seeks care. When preparing to provide the discharge instructions to the client, what are the responsibilities of the nurse?

1. The nurse is required to provide the client with an English-to-Spanish translation dictionary.

2. The nurse should provide instructions written in English along with the contact number for a translator.

3. The nurse has the responsibility to seek all available resources to provide information the client will understand.

4. The nurse is expected to provide a translator fluent in the clients primary language.

Correct Answer: 3

Rationale 1: Providing a translation dictionary does not ensure the client has adequate information to understand the plan of care.

Rationale 2: The types of resources available will vary depending upon the geographical area of the clinic as well as the language spoken and understood by the client. Translator availability will vary.

Rationale 3: The nurse has the responsibility to seek available resources to ensure the client understands the care and treatment being provided.

Rationale 4: The types of resources available will vary depending upon the geographical area of the clinic as well as the language spoken and understood by the client.

Global Rationale: The nurse has the responsibility to seek available resources to ensure the client understands the care and treatment being provided. The types of resources available will vary depending upon the geographical area of the clinic as well as the language spoken and understood by the client. Providing a translation dictionary does not ensure the client has adequate information to understand the plan of care. Translator availability will vary.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4.4: Explain personal strategies that the nurse can use to develop cultural competence when assessing clients from specific cultural groups.

Question 23

Type: MCSA

The nurse is assigned to provide postoperative care to a Chinese American client. Which of the following traditional Chinese cultural concepts may impact the nurse-client interaction?

1. The client may dislike being touched by strangers.

2. Health is associated with being overweight.

3. There is a strong belief in the use of herbs to manage illness.

4. Ceremonies are an important part in the recognition of illness and disease.

Correct Answer: 1

Rationale 1: The Chinese American client may dislike being touched by strangers.

Rationale 2: The association of health and being overweight is a traditional belief of the Cuban American client.

Rationale 3: The use of herbs is a traditional belief of the Cuban American client.

Rationale 4: The use of ceremonies is a traditional belief of the Cuban American client.

Global Rationale: The Chinese American client may dislike being touched by strangers. The association of health and being overweight, and the use of herbs and ceremonies are the traditional beliefs of the Cuban American client.

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 24

Type: MCSA

A Filipino American is preparing for discharge from the hospital. While providing instructions concerning follow-up care, the nurse notes the client is nodding in agreement in response to the nurses statements. After completing the exchange of information, which of the following actions should the nurse take first?

1. The clients understanding of the discharge instructions should be documented.

2. The nurse should ask the client if she understood the information being relayed.

3. The nurse should ask the client questions to assess understanding of the information provided.

4. The client should be asked to sign the discharge paperwork.

Correct Answer: 3

Rationale 1: The clients nodding may simply indicate hearing the information being provided.

Rationale 2: Asking the client if she understands is a closed question and may not determine adequate information.

Rationale 3: The clients nodding may simply indicate hearing the information being provided. The nurse should ask questions to assess understanding.

Rationale 4: The clients signature on the discharge paperwork may be indicated as a part of the discharge plan but is not the next step that should be taken by the nurse.

Global Rationale: The clients nodding may simply indicate hearing the information being provided. The nurse should ask questions to assess understanding. Asking the client if she understands is a closed question and may not determine adequate information. The clients signature on the discharge paperwork may be indicated as a part of the discharge plan but is not the next step that should be taken by the nurse.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 25

Type: MCSA

When planning care to manage osteoporosis in an African American client, which of the following must be taken into consideration?

1. The daily dietary intake contains bread at every meal.

2. Snacks often replace meals beginning in adolescence.

3. Lactose intolerance may be a factor.

4. Pork is not allowed in the diet.

Correct Answer: 3

Rationale 1: Bread and pork are factors to be considered when providing nutritional care to the Arab American.

Rationale 2: Snacking during adolescence is a health concern for the Appalachian population.

Rationale 3: Lactose intolerance is estimated to affect 75% of the African American population. This factor may impact dietary choices available and recommended to manage osteoporosis.

Rationale 4: Bread and pork are factors to be considered when providing nutritional care to the Arab American.

Global Rationale: Lactose intolerance is estimated to affect 75% of the African American population. This factor may impact dietary choices available and recommended to manage osteoporosis. Bread and pork are factors to be considered when providing nutritional care to the Arab American. Snacking during adolescence is a health concern for the Appalachian population. In addition, bread, pork, and snacks do not relate to osteoporosis.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 26

Type: MCSA

The nurse is caring for a Jewish client with type 1 diabetes mellitus who has been taken to another department for testing. The nurse recognizes the client will be due for an insulin injection and will need to eat immediately upon arrival back to the unit. The nurse orders the clients meal tray. Which of the following will be the best selection?

1. BLT sandwich, potato salad, fruit wedge, and unsweetened tea

2. Roast beef sandwich, potato chips, and 2% milk

3. Egg salad sandwich, side salad, applesauce, and diet soda.

4. Pork tenderloin sandwich, fruit cup, and milk.

Correct Answer: 3

Rationale 1: The Jewish client is least likely to be accepting of meals containing pork.

Rationale 2: Meat and milk are not served in the same meal.

Rationale 3: The Jewish client is least likely to be accepting of meals containing pork. The menu of egg salad, a side salad, applesauce, and diet soda does not violate Jewish religious customs.

Rationale 4: The Jewish client is least likely to be accepting of meals containing pork. In addition, meat and milk are not served in the same meal.

Global Rationale: The Jewish client is least likely to be accepting of the meal containing pork. In addition, meat and milk are not served in the same meal. The menu of egg salad, a side salad, applesauce, and diet soda does not violate Jewish religious customs.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 27

Type: MCSA

A Filipino American client is discussing concerns related to osteoporosis with the nurse educator. When considering the information to be presented, the nurse is aware that which of the following traditional characteristics may pose problems for this clients plan of care and will need to be incorporated into the information provided?

1. Potential for lactose intolerance

2. Pork is a primary source of protein

3. Heavy use of salt and vinegar

4. Chicken is a primary source of protein

Correct Answer: 1

Rationale 1: The Filipino American has a higher than average risk to be lactose intolerant. Lactose intolerance may make ingestion of dairy products challenging.

Rationale 2: The clients preferred sources of protein are not a source of concern.

Rationale 3: The use of salt and vinegar for seasoning are not concerns for the client who has concerns related to osteoporosis.

Rationale 4: The clients preferred sources of protein are not a source of concern.

Global Rationale: The Filipino American has a higher than average risk to be lactose intolerant. Lactose intolerance may make ingestion of dairy products challenging. The clients preferred sources of protein are not a source of concern. The use of salt and vinegar for seasoning are not concerns for the client who has concerns related to osteoporosis.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 28

Type: MCSA

The nurse is caring for a Vietnamese female client. When planning to provide care the nurse should include understanding of which of the following concepts?

1. The client will be most respectful of the nurse if direct eye contact is maintained.

2. The client may require a greater than usual amount of personal space.

3. The client will use periods of silence to indicate acceptance of the care interventions proposed.

4. The client will appreciate the nurses attempt to engage in a casual discussion about her feelings.

Correct Answer: 2

Rationale 1: The culture often does not engage in direct eye contact as it is deemed disrespectful.

Rationale 2: The traditional Vietnamese client will appreciate an increase allowance of personal space.

Rationale 3: Periods of silence are used to demonstrate negative emotion.

Rationale 4: Discussion of personal feelings is discouraged.

Global Rationale: The traditional Vietnamese client will appreciate an increase allowance of personal space. The culture often does not engage in direct eye contact as it is deemed disrespectful. Periods of silence are used to demonstrate negative emotion. Discussion of personal feelings is discouraged.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 29

Type: MCSA

The nurse caring for a Navajo woman notices the client is often quiet when she is attempting to interact with her. What inferences can best be made about this behavior?

1. The client likely does not understand the nurses attempts to engage her.

2. The client is demonstrating disapproval with the nurse through the use of silence.

3. The client is uneasy speaking with the nurse without the male head of her household.

4. The client is illustrating agreement with the nurses actions by using silence.

Correct Answer: 4

Rationale 1: There is no indication the client is having difficulty understanding the interaction.

Rationale 2: There is no indication the client is failing to agree with the nurse.

Rationale 3: There is no indication the client is having difficulty speaking with the nurse without the male head of her household.

Rationale 4: The use of silence in the Navaho culture indicates agreement. In differing cultures silence may indicate a lack of understanding, disapproval, or discomfort.

Global Rationale: The use of silence in the Navaho culture indicates agreement. In differing cultures silence may indicate a lack of understanding, disapproval, or discomfort. There is no indication the client is having difficulty understanding the interaction, is failing to agree with the nurse, or is having difficulty speaking with the nurse without the male head of her household.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4.3: Describe cultural phenomena that impact health care.

Question 30

Type: MCMA

The nurse educator is discussing culture and ethnicity with a group of student nurses. Which statement by a student indicates the need for further education?

Standard Text: Select all that apply.

1. The gene pool in the United States has become less diverse over the past decade.

2. I have found it easiest to classify individuals with cultural groups by assessing their skin tones and facial features.

3. When identifying individuals of the same race, they will have shared genetic heritage, biologic and physiologic characteristics.

4. Ethnic groups share common values over generations.

5. An individual may self-identify with an ethnic group that is different from the ethnic group of their birth or race.

Correct Answer: 1,2,3

Rationale 1: The gene pool in the United States has become less diverse over the past decade. The United States represents a population of diverse individuals. There has been an increase in blending races. Many individuals now classify themselves as biracial or multiracial.

Rationale 2: I have found it easiest to classify individuals with cultural groups by assessing their skin tones and facial features. The use of skin tone or facial features is not an acceptable means to determine racial or cultural heritage. This method of assessment and classification is shortsighted and may result in errors.

Rationale 3: When identifying individuals of the same race they will have shared genetic heritage, biologic and physiologic characteristics. Genetic heritage and biologic and physiologic characteristics may not all be shared between all members of the same race.

Rationale 4: Ethnic groups share common values over generations. The awareness of belonging to a group in which certain characteristics or aspects such as culture and biology differentiate the members of one group from another is the concept of ethnicity. It is defined by a shared interest, heritage, religion, food, politics, or geography and nationality

Rationale 5: An individual may self identify with an ethnic group that is different from the ethnic group of their birth or race. Inclusion in an ethnic group may be self-directed. An individual may share the viewpoints, geography, and nationality of an ethnic group by personal choice.

Global Rationale: The United States represents a population of diverse individuals. There has been an increase in blending races. Many individuals now classify themselves as biracial or multiracial. The use of skin tone or facial features is not an acceptable means to determine racial or cultural heritage. This method of assessment and classification is shortsighted and may result in errors. Genetic heritage and biologic and physiologic characteristics may not all be shared between all members of the same race. The awareness of belonging to a group in which certain characteristics or aspects such as culture and biology differentiate the members of one group from another is the concept of ethnicity. It is defined by a shared interest, heritage, religion, food, politics, or geography and nationality. Inclusion in an ethnic group may be self-directed. An individual may share the viewpoints, geography, and nationality of an ethnic group by personal choice.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4.2: Identify terms related to culture.

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