Nursing A Concept Based Approach to Learning Volume II 2nd Ed

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Nursing A Concept Based Approach to Learning Volume II 2nd Ed

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Nursing A Concept Based Approach to Learning Volume II 2nd Ed

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)

Module 24   Culture and Diversity

 

The Concept of Culture and Diversity

 

1) A female client is being discharged after a lengthy hospitalization. The family is from a male-dominated culture. What should the nurse do before providing discharge instructions?

  1. A) Assess who the decision maker is in the family.
  2. B) Make sure that the physician gives the instructions.
  3. C) Make sure instructions are understood by the client.
  4. D) Ask the client when the best time for teaching would be.

Answer:  A

Explanation:  A) 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, the nurse needs to include that individual in healthcare discussions. Regardless of who is present during the teaching, it is always necessary to make sure that the instructions are understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present.

  1. B) 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, the nurse needs to include that individual in healthcare discussions. Regardless of who is present during the teaching, it is always necessary to make sure that the instructions are understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present.
  2. C) 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, the nurse needs to include that individual in healthcare discussions. Regardless of who is present during the teaching, it is always necessary to make sure that the instructions are understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present.
  3. D) 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, the nurse needs to include that individual in healthcare discussions. Regardless of who is present during the teaching, it is always necessary to make sure that the instructions are understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present.

Page Ref: 1634

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  1. Describe how belief systems impact the provision of health care.

 

2) A new graduate nurse is working in a busy Emergency Department of a hospital, situated in a culturally diverse area of the city. What should the nurse do when providing culturally competent care?

  1. A) Possess the underlying background knowledge that will provide these clients with the best possible health care.
  2. B) Understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills.
  3. C) Strive to be culturally sensitive, culturally appropriate, and culturally competent.
  4. D) Try to learn about the attitudes toward health care and traditions of the different cultures in that area.

Answer:  A

Explanation:  A) Cultural appropriateness is to understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills. Cultural sensitivity implies possessing basic knowledge of the cultural groups the nurse will likely encounter and developing constructive attitudes about their health traditions. Cultural competence is possessing the underlying background knowledge that will provide clients with the best possible health care. The definition of professional nursing care is to strive for cultural sensitivity, cultural appropriateness, and cultural competence.

  1. B) Cultural appropriateness is to understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills. Cultural sensitivity implies possessing basic knowledge of the cultural groups the nurse will likely encounter and developing constructive attitudes about their health traditions. Cultural competence is possessing the underlying background knowledge that will provide clients with the best possible health care. The definition of professional nursing care is to strive for cultural sensitivity, cultural appropriateness, and cultural competence.
  2. C) Cultural appropriateness is to understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills. Cultural sensitivity implies possessing basic knowledge of the cultural groups the nurse will likely encounter and developing constructive attitudes about their health traditions. Cultural competence is possessing the underlying background knowledge that will provide clients with the best possible health care. The definition of professional nursing care is to strive for cultural sensitivity, cultural appropriateness, and cultural competence.
  3. D) Cultural appropriateness is to understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills. Cultural sensitivity implies possessing basic knowledge of the cultural groups the nurse will likely encounter and developing constructive attitudes about their health traditions. Cultural competence is possessing the underlying background knowledge that will provide clients with the best possible health care. The definition of professional nursing care is to strive for cultural sensitivity, cultural appropriateness, and cultural competence.

Page Ref: 1640

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  7. Examine personal beliefs, prejudgment, and areas for professional development related to cultural differences and vulnerable populations.

 

3) A nurse is explaining the need to obtain laboratory tests on client who has an infection and is of a cultural group different from the nurses. During the interview, the client averts her eyes and refrains from answering questions for long periods of time. What does this behavior indicate to the nurse?

  1. A) In this clients culture direct eye contact may show disrespect.
  2. B) Come back at a different time, when the client is feeling more communicative.
  3. C) Have another nurse finish the interview, because there is something uncomfortable the client senses.
  4. D) Leave the room and come back after having learned more about this particular culture.

Answer:  A

Explanation:  A) Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. In some cultures direct eye contact may indicate disrespect. In addition, some cultures are quite comfortable with long periods of silence. 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.

  1. B) Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. In some cultures direct eye contact may indicate disrespect. In addition, some cultures are quite comfortable with long periods of silence. 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.
  2. C) Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. In some cultures direct eye contact may indicate disrespect. In addition, some cultures are quite comfortable with long periods of silence. 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.
  3. D) Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. In some cultures direct eye contact may indicate disrespect. In addition, some cultures are quite comfortable with long periods of silence. 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.

Page Ref: 1638

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  5. Distinguish variations of social behaviors found in diverse groups.

 

4) The nurse is caring for an African-American male client who had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the clients diet to be very high in fat. What is the best plan by the nurse to improve the clients diet and reduce the risk that the client may need additional medications?

  1. A) Ask another nurse to speak to him about a low-fat diet.
  2. B) With the clients permission, discuss his diet with whoever prepares meals for the family.
  3. C) Consult a dietician to teach the client about low-fat diets.
  4. D) Give the client information specific to African Americans about low-fat diets.

Answer:  B

Explanation:  A) Every culture has culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having an African-American nurse speak to him is racist and implies that the nurse cannot understand the dietary needs of an African-American client. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.

  1. B) Every culture has culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having an African-American nurse speak to him is racist and implies that the nurse cannot understand the dietary needs of an African-American client. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.
  2. C) Every culture has culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having an African-American nurse speak to him is racist and implies that the nurse cannot understand the dietary needs of an African-American client. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.
  3. D) Every culture has culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having an African-American nurse speak to him is racist and implies that the nurse cannot understand the dietary needs of an African-American client. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.

Page Ref: 1632

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Discuss how cultural and religious preferences may impact an individuals lifestyle and healthcare choices.

 

5) The nurse is evaluating the following goal: Client will select low-fat foods from a list by the end of the month. The client, who has different beliefs about food, has not been able to achieve this goal. What should the nurse do?

  1. A) Extend the time frame and give the client a longer period to achieve the goal.
  2. B) Select a different goal.
  3. C) Make sure that the client understands the importance of the goal.
  4. D) Modify the plan of care to be consistent with the clients beliefs regarding food.

Answer:  D

Explanation:  A) 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 and modify the plan of care to be consistent with the clients belief regarding food. Extending the time frame, selecting a different goal, or 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.

  1. B) 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 and modify the plan of care to be consistent with the clients belief regarding food. Extending the time frame, selecting a different goal, or 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.
  2. C) 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 and modify the plan of care to be consistent with the clients belief regarding food. Extending the time frame, selecting a different goal, or 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.
  3. D) 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 and modify the plan of care to be consistent with the clients belief regarding food. Extending the time frame, selecting a different goal, or 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.

Page Ref: 1629

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  1. Describe how belief systems impact the provision of health care.

 

6) The nurse places a client in a treatment room of the Emergency Department for treatment of abdominal pain and vaginal bleeding. The client is a female of the Islamic culture. The husband of the client speaks for the woman and asks that only a female doctor examine his wife for the pelvic exam. What should the nurse explain to provide culturally appropriate care for this client?

  1. A) The client will be covered with a sheet so it will not matter whether the examiner is male or female.
  2. B) The male and female doctors both respect the clients privacy.
  3. C) The request is unreasonable and cannot be honored.
  4. D) Every attempt will be made to honor their request.

Answer:  D

Explanation:  A) Many cultures have religious beliefs that prohibit examination by men of the reproductive areas of a female. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a clients privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the clients cultural need.

  1. B) Many cultures have religious beliefs that prohibit examination by men of the reproductive areas of a female. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a clients privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the clients cultural need.
  2. C) Many cultures have religious beliefs that prohibit examination by men of the reproductive areas of a female. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a clients privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the clients cultural need.
  3. D) Many cultures have religious beliefs that prohibit examination by men of the reproductive areas of a female. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a clients privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the clients cultural need.

Page Ref: 1643

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Describe how cultural values and beliefs are learned or transmitted.

 

7) The client is admitted to the hospital following a miscarriage, and she is septic. The physician orders antibiotics, which the client refuses, stating, I dont deserve them. I lost my baby because I had sex outside of marriage. What is the most appropriate response by the nurse?

  1. A) Ill call your physician and let him know about your decision.
  2. B) Do you think you should be punished because you had a miscarriage?
  3. C) I think you need to do what is best for you.
  4. D) You have a serious infection and really need the medication.

Answer:  D

Explanation:  A) Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is inappropriate; the nurse knows she needs the medication. Calling the physician is inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is inappropriate; she is septic and needs the medication.

  1. B) Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is inappropriate; the nurse knows she needs the medication. Calling the physician is inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is inappropriate; she is septic and needs the medication.
  2. C) Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is inappropriate; the nurse knows she needs the medication. Calling the physician is inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is inappropriate; she is septic and needs the medication.
  3. D) Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is inappropriate; the nurse knows she needs the medication. Calling the physician is inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is inappropriate; she is septic and needs the medication.

Page Ref: 1631

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Discuss how cultural and religious preferences may impact an individuals lifestyle and healthcare choices.

 

8) The nurse is caring for a male Chinese client who has just had abdominal surgery. The clients nonverbal cues indicate the client is experiencing pain, but the client denies the need for pain medication. What is the best action for the nurse to take?

  1. A) Seek out a family member to convince the client to take the medication.
  2. B) Consult with the physician about providing pain medication without the clients knowledge.
  3. C) Offer the pain medication to the client again, stating that his comfort is the nurses most important responsibility.
  4. D) Allow the client to suffer in silence.

Answer:  C

Explanation:  A) Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people of this culture will consider refusal of something offered as a gesture of courtesy. The nurse should take these into account and offer the pain medication to the client.

  1. B) Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people of this culture will consider refusal of something offered as a gesture of courtesy. The nurse should take these into account and offer the pain medication to the client.
  2. C) Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people of this culture will consider refusal of something offered as a gesture of courtesy. The nurse should take these into account and offer the pain medication to the client.
  3. D) Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people of this culture will consider refusal of something offered as a gesture of courtesy. The nurse should take these into account and offer the pain medication to the client.

Page Ref: 1631

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  8. Plan care for clients that reflects inclusion of a clients cultural values and beliefs.

 

9) The nurse is caring for an infant in the clinic during a routine wellness exam. The parents and infant are of an African ethnic origin and immigrated to America 6 months ago. The mother explains that she believes that an herbal remedy, prepared by the village doctor, is the best way to treat the infants colic. What should the nurse do?

  1. A) Ask the mother what the ingredients are in the remedy.
  2. B) Give the mother an alternate remedy for colic.
  3. C) Explain how herbal ingredients may be harmful to the infant.
  4. D) Tell the mother not to use the remedy because there is no way to know what the ingredients scientific effect may be.

Answer:  A

Explanation:  A) To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.

  1. B) To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.
  2. C) To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.
  3. D) To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.

Page Ref: 1638

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  8. Plan care for clients that reflects inclusion of a clients cultural values and beliefs.

 

10) During a sexual history, a female client states that she has always felt like a man trapped in a womans body. With what should the nurse realize this feeling is associated?

  1. A) Bisexuality
  2. B) Heterosexuality
  3. C) Homosexuality
  4. D) Transsexuality

Answer:  D

Explanation:  A) The medical profession considers transsexuals to have a condition known as gender dysphoria or gender identity disorder, which is defined as a strong and persistent feeling of discomfort with ones assigned gender. The woman states she has always felt like a man trapped in a womans body, which is a description of this phenomenon.

  1. B) The medical profession considers transsexuals to have a condition known as gender dysphoria or gender identity disorder, which is defined as a strong and persistent feeling of discomfort with ones assigned gender. The woman states she has always felt like a man trapped in a womans body, which is a description of this phenomenon.
  2. C) The medical profession considers transsexuals to have a condition known as gender dysphoria or gender identity disorder, which is defined as a strong and persistent feeling of discomfort with ones assigned gender. The woman states she has always felt like a man trapped in a womans body, which is a description of this phenomenon.
  3. D) The medical profession considers transsexuals to have a condition known as gender dysphoria or gender identity disorder, which is defined as a strong and persistent feeling of discomfort with ones assigned gender. The woman states she has always felt like a man trapped in a womans body, which is a description of this phenomenon.

Page Ref: 1634

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  4. Compare and contrast the diverse needs of vulnerable populations.

 

11) A nurse is working at a healthcare clinic serving the needs of an inner-city, predominantly African-American population. A neighbor says the nurse must be brave because most of those people have guns and are in gangs. What would be the nurses best response?

  1. A) Its very difficult for me when you discriminate like that.
  2. B) Its okay because Im not a gang member so I will be okay.
  3. C) Hey, its a job like any other job. All jobs have problems.
  4. D) Thats an unfortunate stereotype. Can we talk about the reality?

Answer:  D

Explanation:  A) It is the nurses role to promote the act of bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the neighbors comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbors perceptions does not promote cultural brokering.

  1. B) It is the nurses role to promote the act of bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the neighbors comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbors perceptions does not promote cultural brokering.
  2. C) It is the nurses role to promote the act of bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the neighbors comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbors perceptions does not promote cultural brokering.
  3. D) It is the nurses role to promote the act of bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the neighbors comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbors perceptions does not promote cultural brokering.

Page Ref: 1634

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Identify disparities in the provision of or access to health care among cultural groups and vulnerable populations.

 

12) A nurse is interviewing a client at a clinic near a shelter for the homeless. Understanding the lack of resources this client has available, what should the nurse ask the client about during the intake phase of the interview?

Select all that apply.

  1. A) Social support available
  2. B) Access to medication
  3. C) Access to nutritious meals
  4. D) Number of times married
  5. E) Any personal resources

Answer:  A, B, C, E

Explanation:  A) Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.

  1. B) Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.
  2. C) Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.
  3. D) Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.
  4. E) Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.

Page Ref: 1635

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Identify disparities in the provision of or access to health care among cultural groups and vulnerable populations.

 

13) A nurse is working with a number of clients at a free clinic. Which client population is at a high risk for low levels of health care?

  1. A) Undocumented immigrants
  2. B) Men who have protected sex with men
  3. C) Men who have sex with women
  4. D) Teenagers

Answer:  A

Explanation:  A) The term vulnerable population refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status.

  1. B) The term vulnerable population refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status.
  2. C) The term vulnerable population refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status.
  3. D) The term vulnerable population refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status.

Page Ref: 1636

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  6. Identify disparities in the provision of or access to health care among cultural groups and vulnerable populations.

 

14) Which treatment program would be most appropriate for homeless clients whose type 1 diabetes requires daily insulin injections?

  1. A) Home health care
  2. B) Outpatient clinic
  3. C) Partial hospitalization programs
  4. D) Inpatient hospital-based care

Answer:  B

Explanation:  A) The outpatient clinic would provide the care the client requires in the most cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is homeless, home health care would not be the best option in this situation.

  1. B) The outpatient clinic would provide the care the client requires in the most cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is homeless, home health care would not be the best option in this situation.
  2. C) The outpatient clinic would provide the care the client requires in the most cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is homeless, home health care would not be the best option in this situation.
  3. D) The outpatient clinic would provide the care the client requires in the most cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is homeless, home health care would not be the best option in this situation.

Page Ref: 1635

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Planning

Learning Outcome:  6. Identify disparities in the provision of or access to health care among cultural groups and vulnerable populations.

 

15) The new nurse working in an inner-city hospital that serves a diverse client population states that she wants to learn everything possible about all of the clients. What is the best response other nursing staff can give the new nurse?

  1. A) I will give you a great book that describes all of the critical factors.
  2. B) You should always be nonjudgmental.
  3. C) This will come with time as you get to know clients and then encounter problems.
  4. D) You need to first understand who you are.

Answer:  D

Explanation:  A) It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.

  1. B) It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.
  2. C) It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.
  3. D) It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.

Page Ref: 1630

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  7. Examine personal beliefs, prejudgment, and areas for professional development related to cultural differences and vulnerable populations.

 

16) The nurse is reviewing the discharge instructions for administration of home medications with a 78-year-old client. In considering the normal changes experienced with aging, which activity should the nurse incorporate into the teaching plan?

  1. A) Giving written materials to compensate for short-term memory losses
  2. B) Considering holding sessions for longer periods than usual so the client can learn
  3. C) Using tools that repeat the information until the information is understood
  4. D) Providing instruction to relatives so that the client will not need to learn everything

Answer:  C

Explanation:  A) Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. Short-term memory, or primary memory, remains relatively stable. Assuming the client cannot learn everything is a stereotypical belief about the aging process. Another age-related change includes the inability to maintain sustained attention. Therefore, long teaching sessions would not be appropriate.

  1. B) Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. Short-term memory, or primary memory, remains relatively stable. Assuming the client cannot learn everything is a stereotypical belief about the aging process. Another age-related change includes the inability to maintain sustained attention. Therefore, long teaching sessions would not be appropriate.
  2. C) Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. Short-term memory, or primary memory, remains relatively stable. Assuming the client cannot learn everything is a stereotypical belief about the aging process. Another age-related change includes the inability to maintain sustained attention. Therefore, long teaching sessions would not be appropriate.
  3. D) Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. Short-term memory, or primary memory, remains relatively stable. Assuming the client cannot learn everything is a stereotypical belief about the aging process. Another age-related change includes the inability to maintain sustained attention. Therefore, long teaching sessions would not be appropriate.

Page Ref: 1637

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  4. Compare and contrast the diverse needs of vulnerable populations.

 

17) A nurse working in an assisted care facility is preparing an educational program regarding ageism for the colleagues on the unit. Which statement or statements reflect ageism?

Select all that apply.

  1. A) If the client is competent to make decisions I should not go to other members of the family for care decisions.
  2. B) The elderly are just lazy and that is why they need help with activities of daily living.
  3. C) All elderly people are sickly.
  4. D) Addressing an elderly client as Honey or Sweetie is disrespectful.
  5. E) The elderly are less likely to recover from illness.

Answer:  B, C, E

Explanation:  A) Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if competent to do so.

  1. B) Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if competent to do so.
  2. C) Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if competent to do so.
  3. D) Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if competent to do so.
  4. E) Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if competent to do so.

Page Ref: 1637

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Evaluation

Learning Outcome:  4. Compare and contrast the diverse needs of vulnerable populations.

 

18) What acculturation behavior will the nurse observe in a client who has emigrated from Mexico to the United States?

  1. A) The client buys all needed products from the local store owned by people from Mexico.
  2. B) The client lives in a neighborhood that is populated predominantly with people from Mexico.
  3. C) The client speaks Spanish only.
  4. D) The client attends church in the neighboring community to meet new people.

Answer:  D

Explanation:  A) Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the clients Mexican culture.

  1. B) Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the clients Mexican culture.
  2. C) Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the clients Mexican culture.
  3. D) Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the clients Mexican culture.

Page Ref: 1634

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  2. Describe how cultural values and beliefs are learned or transmitted.

 

19) The nurse notices that a client, who is from another country, appears uncomfortable when the nurse asks to look at the clients abdominal incision from a recent surgery. Which nursing action is the most culturally competent?

  1. A) Close the clients curtain to maintain privacy.
  2. B) Ask the client to explain why she is uncomfortable.
  3. C) Explain the reason for the intervention using lay terms.
  4. D) Wait until the next assessment time to observe the incision.

Answer:  C

Explanation:  A) The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the clients curtain to maintain privacy for all clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is inappropriate, as this can lead to missing important assessment findings regarding the state of the clients incision.

  1. B) The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the clients curtain to maintain privacy for all clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is inappropriate, as this can lead to missing important assessment findings regarding the state of the clients incision.
  2. C) The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the clients curtain to maintain privacy for all clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is inappropriate, as this can lead to missing important assessment findings regarding the state of the clients incision.
  3. D) The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the clients curtain to maintain privacy for all clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is inappropriate, as this can lead to missing important assessment findings regarding the state of the clients incision.

Page Ref: 1629

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  3. Discuss how cultural and religious preferences may impact an individuals lifestyle and healthcare choices.

 

20) A male nurse enters the room of a female client to obtain the clients vital signs. The clients spouse appears uncomfortable with the nurse and moves closer to the client. What is the best action by the clients nurse?

  1. A) Ask a female staff member to obtain the clients vital signs.
  2. B) Ask the clients spouse to leave the clients room.
  3. C) Perform the intervention without discussion.
  4. D) Explain the procedure to both the client and clients family member.

Answer:  D

Explanation:  A) The nurse should explain the procedure to both the client and the clients family member. Asking another staff member to obtain the clients vital signs is inappropriate. The spouse does not need to leave the clients room. Performing an intervention without first discussing it and asking for permission may be interpreted as assault.

  1. B) The nurse should explain the procedure to both the client and the clients family member. Asking another staff member to obtain the clients vital signs is inappropriate. The spouse does not need to leave the clients room. Performing an intervention without first discussing it and asking for permission may be interpreted as assault.
  2. C) The nurse should explain the procedure to both the client and the clients family member. Asking another staff member to obtain the clients vital signs is inappropriate. The spouse does not need to leave the clients room. Performing an intervention without first discussing it and asking for permission may be interpreted as assault.
  3. D) The nurse should explain the procedure to both the client and the clients family member. Asking another staff member to obtain the clients vital signs is inappropriate. The spouse does not need to leave the clients room. Performing an intervention without first discussing it and asking for permission may be interpreted as assault.

Page Ref: 1643

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  8. Plan care for clients that reflects inclusion of a clients cultural values and beliefs.

 

21) The nurse caring for an adult client from another country notices that the client consults with her mother on all healthcare decisions. What action by the nurse is the most culturally competent?

  1. A) Ask the client why the parent is being consulted for every decision.
  2. B) Accept the behavior of the client and family member.
  3. C) Ask the clients mother to leave the room to provide the client with more privacy.
  4. D) Confront the clients mother to state the importance of the client making her own decisions.

Answer:  B

Explanation:  A) The nurse should accept this behavior as a cultural norm. All other choices are inappropriate and do not consider the clients cultural or family values.

  1. B) The nurse should accept this behavior as a cultural norm. All other choices are inappropriate and do not consider the clients cultural or family values.
  2. C) The nurse should accept this behavior as a cultural norm. All other choices are inappropriate and do not consider the clients cultural or family values.
  3. D) The nurse should accept this behavior as a cultural norm. All other choices are inappropriate and do not consider the clients cultural or family values.

Page Ref: 1634

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  8. Plan care for clients that reflects inclusion of a clients cultural values and beliefs.

 

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)

Module 36   Clinical Decision Making

 

The Concept of Clinical Decision Making

 

1) A nurse has just received a shift report and is preparing to care for clients assigned on a medical-surgical unit. Which client should the nurse plan to assess first?

  1. A) The client who needs assistance with activities of daily living
  2. B) The client who needs help ambulating to the bathroom
  3. C) The client with a pain rating of 3/10
  4. D) The client experiencing shortness of breath

Answer:  D

Explanation:  A) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.

  1. B) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.
  2. C) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.
  3. D) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.

Page Ref: 2323

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Discuss how clinical decision making impacts quality client outcomes.

 

2) A client with congestive heart failure is having difficulty breathing. Before leaving the room the nurse ensures the client has an over-bed table to lean on when awake if needed to ease breathing. Which technique did the nurse use to make this decision?

  1. A) Delegating a task
  2. B) Priority-setting
  3. C) Conflict resolution
  4. D) Critical thinking

Answer:  D

Explanation:  A) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.

  1. B) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.
  2. C) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.
  3. D) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.

Page Ref: 2316

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Planning

Learning Outcome:  2. Apply behaviors to improve critical thinking skills when providing nursing care.

 

3) A postoperative client prescribed pain medication every 4 to 6 hours is requesting medication every 6 hours. At 4 hours the clients pain level is 8 on a rating scale of 1 to 10. The nurse decides to give the pain medication now. What does this nurses action exemplify?

  1. A) Meeting a client goal
  2. B) Time management skills
  3. C) Prioritizing the clients care
  4. D) A response to a change in the clients condition

Answer:  D

Explanation:  A) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.

  1. B) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.
  2. C) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.
  3. D) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.

Page Ref: 2354

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Evaluation

Learning Outcome:  5. Recognize the importance of critical thinking when making decisions for clinical judgment.

 

4) The nurse is assigned two clients. One client needs postoperative teaching in preparation for discharge and the other client with pneumonia has a PaCO2 of 85. Why does the nurse decide to see the client with pneumonia first?

  1. A) The nurse can delegate postoperative teaching to unlicensed assistive personnel (UAP).
  2. B) The client with pneumonia needs more care than the client needing postoperative teaching.
  3. C) The client with pneumonia may be experiencing respiratory distress.
  4. D) The room of the client with pneumonia is closer than that of the client needing postoperative teaching.

Answer:  C

Explanation:  A) The client with a PaCO2 of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2 as being the greater priority. Placement of the clients room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.

  1. B) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2as being the greater priority. Placement of the clients room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.
  2. C) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2as being the greater priority. Placement of the clients room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.
  3. D) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation

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