Which is essential for the nurse to perform prior to finalizing a family-oriented nursing care plan

The major factor contributing to the increased emphasis on the need for proficiency in cultural nursing practice in the United States is which of the following?

1. An increasing birth rate
2. Increased access to health care services
3. Demographic changes
4. A decreasing rate of immigration

3. Demographic changes
[There is an ongoing shift in the US population that includes a decreasing number of white americans and increasing number of cultural groups.

Which behavior is an initial step in culturally responsive nursing practice?

1. Help the client recognize the need to adapt health practices to fit commonly accepted practices.
2. Discuss the meaning of the medical regimen with the client.
3. Inform the client that lack of adherence to the medical regimen may be detrimental.
4. Ask a cultural broker to explain the relevance of the intervention.

2. Discuss the meaning of the medical regimen with the client
[cultural differences may result in various interpretations of medical regime]

In initiating care for a client from a different culture than the nurse, which of the following would be an appropriate statement?

1. "Since, in your culture, people don't drink ice water, I will bring you hot tea."
2. "Do you have any books I could read about people of your culture?"
3. "Please let me know if I do anything that is not acceptable in your culture."
4. "You will need to set aside your usual customs and practices while you are in the hospital."

3. "Please let me know if I do anything that is not acceptable in your culture."
[the nurse should indicate that he or she is open to diverse views and practices]

Which behavior is most representative of a culturally competent nurse?

1. Helps clients of Native American heritage identify ways to relate more to their culture
2. Helps parents of Latino heritage recognize that their children need to speak English
3. Interprets and validates beliefs of a client with African American heritage
4. Asks a nurse of Japanese heritage to teach others dosage calculations since Asians are good at math

3. Interprets and validates beliefs of a client with African American heritage
[culturally competent implies that, within the delivered care, the nurse understands and attends to the total context of the client's situation, including awareness of immigration, stress factors, and cultural differences]

An outcome of achieving national cultural health goals would be which of the following?

1. All cultures receive the same health care.
2. All people have the same life expectancy.
3. All U.S. residents have access to the same quality of health care.
4. All cultures are fully assimilated into the dominant society.

3. All U.S. residents have access to the same quality of health care
[national cultural health goals include proving equal access to quality health care for everyone]

Which nursing action primarily supports restoring HEALTH using traditional methods?

1. Herbal teas
2. Prayer
3. Wearing symbolic objects
4. Exercise

1. Herbal teas
[herbal teas are examples of restoring a health action, prayer and exercise would be maintaining actions, whereas wearing symbolic objects is a protective action]

A client with strong preferences for folk healing methods would prefer which of the following to treat a sinus infection?

1. Hospitalization
2. Steam humidifier
3. Antibiotic therapy
4. "Watch and wait"

2. Steam humidifier
[steam is a natural substance and would be compatible with folk healing preferences, hospitalization and medication are western medical strategies, watch and wait is not associated with folk healers]

Which of the following factors are most likely to be influenced by culture as opposed to personal characteristics? Select all that apply.

1. Value of older people in society
2. Gender roles
3. Nonverbal gestures
4. Skill with technology
5. Intelligence
6. Diet

1. Value of older people in society
2. Gender roles
3. Nonverbal gestures
6. Diet

What is the most productive method of gathering assessment data regarding heritage?

1. Physical exam
2. Medical history
3. Blood analysis
4. Traditional beliefs and practices checklist

4. Traditional beliefs and practices checklist
[to gather assessment data regarding the client's heritage nurses must explore the client's beliefs and practices. A good beginning would be to ask clients to indicate from the checklist which apply to them]

A client who speaks limited English requires instructions for a test. No one at your agency speaks the person's language. What is the nurse's best approach?

1. Provide the instructions in writing.
2. Locate a professional interpreter.
3. Ask a family member to translate on the phone.
4. Document that the required instruction is not possible.

2. Locate a professional interpreter.
[if an interpreter is not available at your agency, you must still meet the expectations of providing information in a way the client can comprehend it. Providing written instructions whether in english or the client's language is insufficient since the client may not be able to read or remain to have questions answered. family members should not be relied on to interpret medical info]

Which of the following statements about culture is true?

1. Members of a cultural group share the exact same beliefs and values.
2. The term culture-specific refers to values shared by many cultures.
3. Differences can exist among members of the same cultural group
4. The term culture-universal refers to values of a specific culture.

3. Differences can exist among members of the same cultural group
[Major differences within cultural groups may be due to age, gender, level of education, and socioeconomic status. Not all members of a cultural group will share the same beliefs and values. Different cultures rarely have the same values. No one culture has values that universally apply to all other cultures]

Which statement about religion is most accurate?

1. Religious teachings tend to oppose cultural values and norms.
2. Religion is a system of beliefs, practices, and ethical values regarding the creator(s) or ruler(s) of the universe
3. Socialization must take place before religion can be accepted.
4. Religion generally is not related to ethnicity.

2. Religion is a system of beliefs, practices, and ethical values regarding the creator(s) or ruler(s) of the universe
[Culture, religion, and ethnicity shape a person's worldview. Religion often is determined by one's cultural and ethnic group. Religious teachings may begin in early childhood, before the individual is acclimated to society's norms. In most cases, there is a correlation between religion and ethnicity]

While conducting an initial assessment of an infant, a home health nurse notices that she is wearing a soiled red string around her neck. The nurse should:

1. Remove the string, because it is soiled and may pose a risk of strangulation
2. Ask the infant's parents about the significance of the string, and suggest that it be placed more safely on her body
3. Leave the string where it was placed by the infant's parents
4. Inform the parents that the string offers no benefit and ask them to remove it

2. Ask the infant's parents about the significance of the string, and suggest that it be placed more safely on her body
[Always act in the best interest of the client, while demonstrating respect for their values. Removing the string would demonstrate cultural insensitivity. Leaving the string may place the infant at risk for injury. Informing the parents would demonstrate lack of respect for cultural beliefs and interfere with formation of a therapeutic relationship.]

A client with cancer refuses treatment, and tells the nurse, "I will recover through prayer and meditation if it's God's will." According to Andrews and Boyle's description of health beliefs, which of the following belief systems does this client hold?

1. Scientific or biomedical health belief
2. Magico-religious health beliefs
3. Folk medicine health belief
4. Holistic health belief

2. Magico-religious health beliefs
[This client holds Magico-religious health beliefs. Scientific or biomedical health belief is based on the belief that life and life processes are subject to control by humans. Folk medicine is derived from cultural beliefs, rather than a scientific base. Holistic health belief believes that illness is the result of an imbalance between that person and nature]

A nurse is asked to care for a gay male client, but has no experience with gay culture and feels uncomfortable around this client. What would be the most appropriate nursing action?

1. Leaving a pamphlet at the client's bedside explaining the dangers of unsafe sex and the treatment options for homosexuality
2. Avoiding touching the client because he may be HIV-positive
3. Being honest about the lack of experience, and respecting the client's values and practices
4. Acting as though the client is no different than other clients and that the male partner is just a friend of the client

3. Being honest about the lack of experience, and respecting the client's values and practices
[Being honest about the lack of experience, and respecting the client's values and practices, is the most appropriate nursing action. Leaving a pamphlet indicates a lack of respect for the client's beliefs and practices. Avoiding touching is not based on scientific knowledge about the transmission of HIV disease. Acting as if the client is no different may hinder communication between the client and nurse.]

A Native American client with a low-grade fever insists on using a sweat lodge to treat his illness. What is the nurse's best response?

1. Explaining to the client why the sweat lodge may exacerbate his fever
2. Monitoring the client's condition, and keeping in mind that treatment consistent with the client's beliefs will probably be the most successful
3. Asking the client's relatives to convince him not to use the sweat lodge
4. Notifying the physician and asking her to intervene

2. Monitoring the client's condition, and keeping in mind that treatment consistent with the client's beliefs will probably be the most successful
[The nurse's best response is to monitor the client's condition, and to keep in mind that treatment consistent with the client's beliefs probably will be the most successful. The client who doesn't believe in Western medicine will not believe the sweat lodge will worsen his condition. Asking the client's relatives to convince him not to use the sweat lodge would not promote good relations with the client and may violate his right to privacy. The nurse should attempt to find a solution before asking the physician to intervene.]

_________ describes the degree to which one's lifestyle reflects his or her respective tribal culture.

Heritage consistency-Heritage consistency describes the degree to which one's lifestyle reflects his or her respective tribal culture

A nurse is caring for two clients, both of whom have had abdominal surgery. One, a Hispanic, writhes in pain and moans when touched, and the other, an Asian, appears calm and rarely complains of pain or discomfort. Which of the following statements regarding this situation is true?

1. The Asian client is not experiencing pain.
2. The Hispanic client is exhibiting drug-seeking behavior.
3. Culture and ethnicity may affect how a client exhibits distress.
4. The Hispanic client is exaggerating his pain

3. Culture and ethnicity may affect how a client exhibits distress.
[Both have a direct effect on communication style, but the nurse should avoid stereotyping or false assumptions when planning and providing care. The presence or absence of pain must be validated by direct query. The nurse should never be judgmental of a client's behaviors. All complaints of pain by a patient must be believed and addressed.]

A home health nurse in a small Appalachian community is caring for a client at home. The client is an active member of the church, and as death nears, the local minister and many members of the congregation gather in the home for a "death watch." What is the most appropriate nursing action?

1. Explain that medical procedures are more important for the client
2. Allow the family and one visitor at a time to stay with the client, but keep everyone else in the next room
3. Respectfully observe the client's religious beliefs and allow the family and minister unlimited access to the client
4. Ask the minister to tell people to leave if the home is becoming too crowded

3. Respectfully observe the client's religious beliefs and allow the family and minister unlimited access to the client
[Particularly within the setting of a terminal illness, the nurse's most important responsibility is providing physical and spiritual comfort to the client and family. For the client who is dying and has no hope for recovery, spiritual support and contact with the family take precedence over medical procedures. Unless the client expresses a wish to be alone, the nurse should follow local cultural practices and allow the visitors to stay. The nurse should follow local cultural practices unless the client wishes otherwise.]

The process of being raised within a culture and acquiring the characteristics of that group is called __________ .

Socialization or Acculturation
[Acculturation or Socialization is the process of being raised within a culture and acquiring the characteristics of that group is called socialization or acculturation]

1. Because a severely injured middle-aged client informed the nurse that he did not have any immediate family members, the nurse contacted extended family members. Which of the following is most representative of extended family members?

1. Grandparents, aunts and uncles
2. Parents and spouse
3. Children who no longer live at home
4. Roommates and close family friends

1. Grandparents, aunts and uncles

What should a nurse instruct a client who identifies "the family" as two college roommates, a dog, and a cat when completing a family health history form?

1. Include all information about blood relatives and the animals and roommates that might influence his health.
2. Include only information about genetic/hereditary and environmental illnesses of blood relatives.
3. Leave the area blank since the client does not live with blood relatives.
4. Use the client's own judgment in completing the area since the physical exam is more important than the history.

1. Include all information about blood relatives and the animals and roommates that might influence his health.
[the health history of the client's current living partners is critical info since many illness are communicable/environmental]

A visual representation of family members by sex, age, health status, and lines of relationships through the generations is referred to as a __________.

Genogram

To assess the impact of illness on the family as a unit, it is essential for the nurse to assess which factors? Select all that apply.

1. The duration of the illness
2. The meaning of the illness to the family and its significance to family systems
3. The coping mechanisms used by other families with similar illnesses
4. The financial impact of the illness (including factors such as insurance and ability of the ill member to work)
5. The incidence of the illness in the community at large

1. The duration of the illness
2. The meaning of the illness to the family and its significance to family systems
4. The financial impact of the illness (including factors such as insurance and ability of the ill member to work)

[it is essential for the nurse to determine the duration of the illness, the meaning of the illness to the family and its significance tot he family systems, and the financial impact of the illness in order to completely assess the impact of the illness on the family as a whole. Duration of the illness will determine the degree os disruption and adaption required. These factors affect the family members in addition to the ill client]

An adult child brings a parent to an agency with signs and symptoms of potential fluid retention (e.g., high blood pressure, swollen feet) possibly related to excessive sodium intake. Further nursing assessment indicates inadequate food storage and preparation techniques in the home. Which would be the most appropriate nursing diagnosis?

1. Readiness for Enhanced Family Coping
2. Disabled Family Coping
3. Impaired Parenting
4. Caregiver Role Strain

1. Readiness for Enhanced Family Coping
[presenting to the clinic indicates the family is probably read to face the health challenges caused by the previous activities.

Prior to finalizing a family-oriented nursing care plan and implementing interventions, it is essential for the nurse to perform which of the following?

1. Meet with all family members simultaneously.
2. Confirm that the family health insurance covers all family members.
3. Establish a trusting relationship with the family as a group.
4. Complete a thorough history and physical examination of each family member.

Establish a trusting relationship with the family as a group.
[establishing a trust allows for effective communication and confirms that there is a mutual commitment to the goals.

Nurses often utilize systems theory to assess family units. Which example illustrates a family unit that does NOT meet the criteria of a well-functioning system?

1. The family members allow input from outside the family unit.
2. The family members are interdependent.
3. Each member's personal boundaries are well defined.
4. The primary activities of each member focus on personal purposes.

4. The primary activities of each member focus on personal purposes.
[the focus of activity on personal purposes does not promote effective family functioning]

What is a primary function of a family?

1. Provide everything each member wants.
2. Provide an environment that supports growth of individuals.
3. Ensure that the members are accepted into society.
4. Ensure that family resources are not shared with the broader community.

2. Provide an environment that supports growth of individuals
[a family should provide an environment that supports the growth of the individual members]

Which family risk factor for developing a health problem is of highest priority for the nurse to address?

1. Family members' ages 4, 13, 38, 42, and 75 place them in many different developmental stages.
2. There is a history of adult-onset diabetes on the 42-year-old father's side.
3. The primary wage earner for a family of five has recently been let go from the job and lost health insurance.
4. The family members are primarily sedentary and no one engages in physical exercise for more than 1 hour each week.

3. The primary wage earner for a family of five has recently been let go from the job and lost health insurance.
[a family with sudden loss of income and health insurance is at the creates risk for developing a health problem because it may no longer be bale to afford preventive or therapeutic care.

The home health nurse has been assigned to an elderly woman who is cohabitating with her daughter and her son in a one bedroom apartment on the edge of town. The grandson is the primary caregiver at the age of fourteen since his mother is an alcoholic and an unreliable participant in caring for her mother. The home health nurse completes a health history of the client but realizes:

1.The focus of client teaching should be with the grandson
2. The nurse should report the daughter to Child Welfare Agency as an abusive mother
3. The nurse should create a plan of care that includes all members of the family
4. The nurse should congratulate the grandson on his impeccable care of his grandmother

3. The nurse should create a plan of care that includes all members of the family
[In the nursing profession, interest in the family unit and its impact on the health, values, and productivity of the individual family members is expressed by family-centered nursing.]

A bilingual nurse practitioner working in a rural clinic is working with a pregnant mother of four children. The woman who does not speak English has been in the country for several years with her children attending the local public school. In an attempt to teach the expectant mother the value of good nutrition on the neonate's health, the nurse could incorporate which tactic for health promotion activities?

1. Write the information on an information sheet in English for the children to read.
2. Include the bilingual children in the discussion on good nutrition.
3. Give the client a poster with pictures of nutritionally balanced meals and move on.
4. Ask the mother to bring an older friend into the clinic for health promotion activities since the children are too young.

2. Include the bilingual children in the discussion on good nutrition.
[The structural-functional theory focuses on family structure and function. The structural component addresses the membership of the family and relationships among family members. The focus of nursing care should be the inclusion of all family members in health promotion activities. Sharing information with family members may create the achievement of family goals.]

A recently married couple has five children between them. What type of family have they formed?

1. Blended family
2. Cohabiting family
3. Traditional family
4. Single-adult family

1. Blended family
[A blended family consists of two previously existing family units combined together to make a single unit. A cohabiting family is when different families share the same dwelling but don't necessarily combine their other resources, or offer assistance and help to people outside of their own family unit. Members of a traditional family would not have had children from a previous marriage or relationship. A single-adult family has only one adult heading up the family unit.]

Which of the following should a nurse consider when evaluating a family's coping resources?

1. Availability of support persons
2. Family structure
3. Preventive health practices within the family
4. Roles of family members

1. Availability of support persons
[Support persons will be vital in offering assistance and care for the client recovering from illness. Family structure will not have a direct effect on the client's ability to maintain health or recover from illness. Preventive health practices are not related to the client's ability to cope with the stresses and demands of illness. Roles and role performance don't impact the family's coping resources.]

How should the nurse use the concepts of total care and individualized care?

1. By using both total care and individualized care for each client
2. By using total care during the planning phase and individualized care for interactions with a client
3. By using individualized care for clients with special needs and total care for other clients
4. By using total care for clients with special needs and individualized care for other clients

1. By using both total care and individualized care for each client
[Nurses must use all principles and areas that apply when caring for a client, and must plan and organize that care with respect to the client's individual, unique needs. Total care should be used throughout all phases of nursing care. All clients should receive both individualized and total care.]

A fifteen year old girl has been admitted to the Obstetrics unit after delivering her second baby in two years. The focus of health promotion activities should be:

1. Obtaining food stamps to feed the children
2. Methods of birth control
3. A lecture on the perils of unprotected sexual intercourse
4. A discussion on the morality of having children out of wedlock

2. Methods of birth control
[Young parents are often developmentally, physically, emotionally, and financially ill prepared to undertake the responsibility of parenthood. Children born to an adolescent are often at greater risk for health and social problems. Health promotion activities should focus on the developmental preparedness of the client and be completed in a nonjudgmental manner.]

The nurse approaches a family who is living in a shelter for abused women. The mother has bruises around her mouth and on her arms. The nurse asks her if she can perform a physical examination to assess the extent of her injuries. As the nurse begins the examination, the woman recoils from the nurse's touch and screams, "Don't touch me!" The nurse's best response would be:

1. "Relax. I have to check how badly you were beaten."
2. "I am not going to hurt you."
3. "I know that you have been hurt and will try not to hurt you with my touch."
4. "Would you prefer to have another nurse examine you?"

3. "I know that you have been hurt and will try not to hurt you with my touch."
[Family violence has increased in recent years. Spousal abuse may go unreported due to family boundaries. Nurses should be alert to the symptoms of family violence and take appropriate measures to report it and obtain resources for the family.]

After an accident, a mother of a newborn has been discharged home. She has lost the use of her dominant right arm. In planning her discharge, the nurse can use which of the following nursing diagnoses to guide care?

1. Caregiver Role Strain
2. Disabled Family Coping
3. Impaired Parenting
4. Impaired Home Maintenance

4. Impaired Home Maintenance
[Nursing needs to focus on assisting the family to plan realistic goals/outcomes and strategies that enhance family functioning, such as improving communication skills, identifying and utilizing support systems, and developing and rehearsing parenting skills.]

Which of the following is an element of systems theory?

1. Closed system
2. Open system
3. Subsystem
4. Suprasystem

2. Open system
[A system is a set of interacting identifiable parts or components. A system depends on the quality and quantity of its input, throughput, output, and feedback.]

A single mother confides to the nurse that her adolescent son no longer spends time with the family and has withdrawn communication. The client is worried that the son may be taking drugs but cannot be sure. List the appropriate nursing diagnoses available to create a care plan that will assist the family.

-Interrupted family processes r/t
-Readiness for enhanced family coping r/t
-Caregiver role strain r/t

[The challenge for the nurse and family is to disseminate information and data to create a plan that can minimize family dysfunction]

What are the steps of the family nursing process?

What are the responsibilities of a nurse in promoting family health?

Which action is performed in the implementation step in the nursing process?

What should a nurse instruct a client who identifies the family as two college roommates a dog and a cat when completing a family health history form?