Deck 3 Module 24 Flashcards
A female client, from a male-dominated culture, is being discharged after a lengthy hospitalization. Which action by the nurse prior to providing discharge instructions is appropriate?
A) Assess who the decision maker is in the family.
B) Ensure that the healthcare provider gives the instructions.
C) Make sure instructions are understood by the client.
D) Ask the client when the best time for teaching would be.
A) Assess who the decision maker is in the family.
Rationale:
The nurse needs to identify who has the “authority” to make decisions in a client’s family. If the decision maker is someone other than the client, the nurse needs to include that individual in healthcare discussions. Nurses need an awareness of cultural variations of gender because they will be caring for diverse client needs. What might be considered sexism by one culture may not be in another. 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. The nurse should not simply leave giving instructions to the healthcare provider.
A novice nurse is working in a busy emergency department of a hospital situated in a culturally diverse area of the city. Which should the nurse do when providing culturally competent care?
A) Acquire the underlying background knowledge necessary that will provide these clients with the best possible healthcare.
B) Treat everyone who comes to the emergency department seeking care as having the same needs.
C) Assume that working in this emergency department will be the same as in other care contexts the nurse has encountered.
D) Base the standard of care on the needs and attitudes of the dominant cultural group in the area.
A) Acquire the underlying background knowledge necessary that will provide these clients with the best possible healthcare.
Rationale:
As healthcare providers, it is imperative to recognize common prejudices. Prejudices are prejudgments about cultural groups or vulnerable populations that are unfavorable or false because they have been formed without the background knowledge and context upon which to form an accurate opinion. Healthcare providers must acquire this background knowledge to develop their cultural competence. The nurse cannot treat every client as having the same needs, assume that the emergency department does not present a unique context that must be understood on its own terms, or base his standard of care on what best serves a single cultural group, dominant or not.
A nurse is explaining the need to obtain laboratory tests on a client who has an infection and is of a cultural group different from the nurse’s. During the interview, the client avoids eye contact and refrains from answering questions for long periods of time. Which does this behavior indicate to the nurse?
A) In this client’s culture, direct eye contact may show disrespect.
B) The nurse should come back at a different time when the client is feeling more communicative.
C) The nurse should have another nurse finish the interview who might be more culturally aware of this group’s customs.
D) Leave the room and come back after having learned more about this particular culture.
A) In this client’s culture, direct eye contact may show disrespect.
Rationale:
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. The nurse should not leave to come back later or try to find another nurse to take over this client’s care; nurses should be able to communicate with clients from a diversity of backgrounds.
The nurse is caring for a client from a different culture who had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the client’s diet to be very high in fat. Which is the best plan by the nurse to improve the client’s diet and reduce the risk that the client may need additional medications?
A) Ask the client if he would rather have another nurse who is from the same culture speak to him about his dietary needs.
B) With the client’s permission, discuss the dietary requirements with whoever prepares meals for the family.
C) Consult a dietitian to teach the client about low-fat diets.
D) Give the client information specific to his culture related to low-fat diets.
B) With the client’s permission, discuss the dietary requirements with whoever prepares meals for the family.
Rationale:
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 a nurse from the same culture speak to him is racist and implies that the nurse cannot understand the dietary needs of a client from another culture. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.
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. Which action by the nurse is appropriate?
A) Extend the time frame and give the client a longer period to achieve the goal.
B) Select a different goal.
C) Make sure that the client understands the importance of the goal.
D) Modify the plan of care to be consistent with the client’s beliefs regarding food.
D) Modify the plan of care to be consistent with the client’s beliefs regarding food.
Rationale:
If the outcomes are not achieved for a client with different beliefs, the nurse should be especially careful to consider whether the client’s belief system has been adequately included as an influencing factor and modify the plan of care to be consistent with the client’s 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 practices–including dietary ones–of the client.
The nurse places a client in a treatment room of the emergency department for treatment of abdominal pain and vaginal bleeding. The spouse, speaking for the client, asks that only a female provider examine his wife for the pelvic exam. The nurse recognizes that the client is from a culture that prohibits men from examining women. Which is the most culturally appropriate statement by the nurse?
A) “Your spouse will be covered with a sheet, so it will not matter whether the examiner is male or female.”
B) “The male and female providers both respect privacy.”
C) “The request is unreasonable and cannot be honored.”
D) “Every attempt will be made to honor your request.”
D) “Every attempt will be made to honor your request.”
Rationale:
Many cultures have religious beliefs that prohibit men from examining women and women from examining men. 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 client’s 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 client’s cultural need.
The client is admitted to the hospital following a miscarriage, and she is septic. The healthcare provider orders antibiotics, which the client refuses, stating, “I don’t deserve them. I lost my baby because I had sex outside of marriage.” Which is the appropriate response by the nurse?
A) “I’ll notify your healthcare provider about your decision.”
B) “Do you think you should be punished because you had a miscarriage?”
C) “I think you need to do what is best for you.”
D) “You have a serious infection and really need the medication.”
D) “You have a serious infection and really need the medication.”
Rationale:
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 healthcare provider 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.
The nurse is caring for a client who just had abdominal surgery. The client’s nonverbal cues indicate pain, but the client denies the need for the pain medication prescribed by the healthcare provider. The nurse recognizes that this client is from a culture that feels it is inappropriate to complain about pain. Which action by the nurse is appropriate?
A) Seek out a family member to convince the client to take the medication.
B) Consult with the healthcare provider about providing pain medication without the client’s knowledge.
C) Offer the pain medication to the client again, stating that providing comfort is the nurse’s most important responsibility.
D) Allow the client to suffer in silence.
C) Offer the pain medication to the client again, stating that providing comfort is the nurse’s most important responsibility.
Rationale:
Members of some cultures 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 from these cultures will consider refusal of something offered as a gesture of courtesy. The nurse should take this into account when offering the pain medication to the client in a culturally sensitive way. Seeking out the intervention of a family member of the client, trying to administer the medication without the client’s knowledge or simply allowing the client to suffer in silence are not appropriate actions.
The clinic nurse is caring for an infant during a routine wellness exam. The parents and infant immigrated to the United States 6 months ago. The mother explains that she believes that an herbal remedy is the best way to treat the infant’s colic. Which action by the nurse is appropriate?
A) Ask the mother what the ingredients are in the remedy.
B) Give the mother an alternate remedy for colic.
C) Explain how herbal ingredients may be harmful to the infant.
D) Tell the mother not to use the remedy because there is no way to know what the ingredients’ scientific effect may be.
A) Ask the mother what the ingredients are in the remedy.
Rationale:
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.
During a sexual history, the client states, "I have always felt like a man trapped in a woman's body." The nurse should recognize that the client may identify as what? A) Bisexual B) Heterosexual C) Homosexual D) Transgender
D) Transgender
Rationale:
The term transgender refers to individuals who do not identify with the gender assigned to their body. For example, an individual who identifies as transgender may have typical female anatomy but feel like a male and seek to become male by presenting as male and taking hormones or electing to have sex reassignment surgeries. This client’s statement relates to gender identification, not to the sexuality of the client.
A nurse is working at a healthcare clinic serving the needs of an inner-city population that is predominantly made up of minority people groups. A neighbor says the nurse must be brave because most of “those” people have guns and are in gangs. Which response by the nurse is appropriate?
A) “It’s very difficult for me when you discriminate like that.”
B) “It’s okay because I’m not a gang member, so I will be okay.”
C) “Hey, it’s a job like any other job. All jobs have problems.”
D) “That’s an unfortunate stereotype. Can we talk about the reality?”
D) “That’s an unfortunate stereotype. Can we talk about the reality?”
Rationale:
It is the nurse’s 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 neighbor’s comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbor’s perceptions does not promote cultural brokering.
A nurse is interviewing a client at a clinic near a shelter for the homeless. Understanding the lack of resources this client has available, which should the nurse assess during the intake phase of the health history? Select all that apply. A) Social support available B) Access to medication C) Access to nutritious meals D) Number of times married E) Any personal resources
A) Social support available
B) Access to medication
C) Access to nutritious meals
E) Any personal resources
Rationale:
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.
A nurse is working with a number of clients at a free clinic. Which client population is at the highest risk for low levels of healthcare? A) Undocumented immigrants B) Men who have protected sex with men C) Men who have sex with women D) Teenagers
A) Undocumented immigrants
Rationale:
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. Men or teenagers as a group are not more likely to be at risk for lower levels of healthcare.
Which treatment program would be most appropriate for homeless clients whose type 1 diabetes requires daily insulin injections? A) Home healthcare B) Outpatient clinic C) Partial hospitalization programs D) Inpatient hospital-based care
B) Outpatient clinic
Rationale:
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 healthcare would not be the best option in this situation.
The novice nurse working in an inner-city hospital that serves a diverse client population states, “I want to learn everything possible about all of the clients.” Which response by the seasoned nurse is appropriate?
A) “I will give you a great book that describes all of the critical factors.”
B) “You should always be nonjudgmental.”
C) “This will come with time as you get to know clients and then encounter problems.”
D) “You need to first understand who you are.”
D) “You need to first understand who you are.”
Rationale:
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.
