2. A pregnant Haitian woman explains to a nurse that she is wearing a chicken bone around her neck to protect her unborn child from birth defects. Discuss how it would be best to respond to this woman from a culturally sensitive perspective.
NCLEX-STYLE REVIEW Q U E S T I O N S
1. The first step the nurse takes when preparing to teach a Latino client about dietary measures to control diabetes mellitus is to
1. Monitor the client’s blood glucose level each day.
2. Review prescribed drug therapy.
3. Obtain a copy of a calorie-controlled exchange list.
4. Determine the client’s food likes and dislikes.
2. When interviewing an Asian American during admission to a health agency, the best technique for a culturally sensitive nurse to use when asking questions is to posi- tion himself or herself
1. Directly next to the client
2. Just beyond an arm’s length away 3. Within the doorway to the room 4. To facilitate occasional touching
3. While assessing an African-American infant during a home visit, the nurse observes a bluish area on the baby’s buttocks. The action that is best for the nurse to take is to 1. Document the information; it is a normal assess-
ment finding.
2. Report suspicion of physical abuse to Child Protec- tive Services.
3. Notify the physician in charge of the infant’s care about the finding.
4. Examine any and all children in the home for addi- tional signs of abuse.
4. A Native American client reports that a tribal elder used
“smudging,” a ritual in which a substance like sweet grass is burned and the smoke is fanned about the body with an eagle feather, to cleanse him of negative energies during his recent illness. Which response by the nurse is most appropriate?
1. Explain that smudging will not help restore the client’s health.
2. Suggest that the client include the physician’s treat- ment regimen.
3. Report the tribal elder for practicing medicine with- out a license.
4. Advise the client to avoid treatment prescribed by the tribal elder.
C H A P T E R 6 ● Culture and Ethnicity 83
SECTION I: REVIEWING WHAT YOU’VE LEARNED
Activity A: Fill in the blanks by choosing the correct word from the options given in parentheses.
1. means damaging statements written and read by others. (Libel, Misdemeanors, Slander) 2. is the ethical principle that emphasizes the duty to be honest and to avoid deceiving or
misleading clients. (Autonomy, Justice, Veracity)
3. A(n) disorder is acquired from the genetic codes of one or both parents. (congenital, hereditary, idiopathic)
4. Health services to which health care providers refer clients for consultation and additional testing, such as cardiac catheterization, are an example of care. (primary, secondary, tertiary)
5. means physiologic and behavioral responses to disequilibrium. (Adaptation, Holism, Stress) 6. stabilizes mood, induces sleep, and regulates temperature. (Dopamine, Norepinephrine,
Serotonin)
7. is a bond or kinship that a person feels with his or her country of birth or place of ancestral origin. (Culture, Ethnicity, Race)
8. A fixed attitude about all people who share a common characteristic related to age, sex, race, sexual orientation, or ethnicity is called a . (belief, generalization, stereotype)
Activity B: Mark each statement as either T (True) or F (False). Correct any false statements.
1. T F An anecdotal note cannot be used as evidence in court.
2. T F Malpractice is harm that results from acting carelessly in a given circumstance.
3. T F Capitation is a payment system that provides incentives to control the number of tests and services rendered as a means of making a profit.
4. T F In the case method of nursing, one nurse manages all the care needs of a client or group of clients for a designated period.
5. T F Coping mechanisms are stress-reduction activities people select consciously to help them deal with challenging events or situations.
6. T F Receptors for neurotransmitters are found throughout the central nervous, endocrine, and immune systems.
7. T F Ethnocentrism refers to the belief that one’s own ethnicity is superior to all others.
8. T F Florence Nightingale coined the term “transcultural nursing.”
U N I T 2
End of Unit Exercises
for Chapters 3, 4, 5, and 6
84
U N I T 2 ● End of Unit Exercises for Chapters 3, 4, 5, and 6 85 Activity C: Write the correct term for each description below.
1. Unlawful act in which untrue information harms a person’s reputation 2. Person who claims injury and brings charges against another person
3. Sum of physical, emotional, social, and spiritual health, which determines how “whole” or well a person feels
4. Ill effect that results from permanent or progressive organ damage caused by a disease or its treatment
5. A relatively stable state of physiologic equilibrium
6. Natural body chemicals that produce effects similar to those of opiate drugs 7. Disappearance of signs and symptoms associated with a disease
8. Digestive enzyme that converts lactose into glucose and galactose
Activity D: 1. Match the terms in Column A with their definitions in Column B.
Column A
1. Morbidity
2. Mortality
3. Acute illness
4. Chronic illness
2.Match the skin disorders in Column A with their descriptions in Column B.
Column A
1. Keloids
2. Hypopigmentation
3. Vitiligo
4. Mongolian spots
Activity E: 1. Differentiate between teleologic theory and deontologic theory based on the criteria given below.
Teleologic Theory Deontologic Theory
Definition
Ideology
Example
Column B
A. The number of people who died from a particular disease or condition
B. A change in health that develops slowly and lasts a long time, increasing with age
C. The number of people affected by a specific disease, disorder, or injury
D. A change in health that happens suddenly and lasts a short time
Column B
A. Dark-blue areas on the lower backs of darkly pigmented infants and children
B. Irregular, elevated thick scars
C. Damaged skin with temporary redness that fades to a lighter hue
D. Irregular white patches on the skin from a lack of melanin
86 U N I T 2 ● Integrating Basic Concepts
2.Differentiate between the sympathetic and parasympathetic nervous systems based on the criteria given below.
Sympathetic Nervous System Parasympathetic Nervous System Function
Effect on physiologic functions
Example
Activity F: Consider the following figure.
1.
a. Identify the figure.
b. Label the figure.
Activity G: In the 1960s, Abraham Maslow identified and grouped five levels of human needs in a sequential hierarchy according to their significance. In the boxes below, sequence the five levels of human needs as defined by Maslow, moving from those that are most important to those that are least important for survival.
1. Need for esteem and self-esteem 2. Need for self-actualization 3. Need for love and belonging 4. Need for physiologic requirements 5. Need for safety and security
Activity H: Answer the following questions.
1. What are laws? What are the different types of laws?
2. What is the purpose of a nurse practice act?
3. How does the World Health Organization (WHO) define health?
4. What are the five common management patterns that nurses use to administer client care?
5. What is homeostasis? What four categories of stressors affect homeostasis?
6. What factors affect the stress response?
7. What is transcultural nursing care?
SECTION II: APPLYING YOUR KNOWLEDGE
Activity I: Give rationales for the following questions.
1. Why is it important for nurses to obtain their own personal liability insurance?
2. Why does the treatment of idiopathic illness focus on relieving signs and symptoms?
3. Why can a nurse be charged with a criminal offense in the case of gross negligence?
4. Why should the nurse refuse the assistance of untrained interpreters, volunteers, or family when caring for a client with whom the nurse does not share a common language?
U N I T 2 ● End of Unit Exercises for Chapters 3, 4, 5, and 6 87
88 U N I T 2 ● Integrating Basic Concepts
5. Why is it important for the nurse to inspect the skin of the palm, foot, and abdomen during a skin assessment?
6. Why must the nurse avoid making or writing negative comments about clients, physicians, or other coworkers?
Activity J: Answer the following questions, focusing on nursing roles and responsibilities.
1. An unconscious client has been admitted to the health care facility after a motor vehicle crash. When the client regains consciousness, he wants to leave the facility without being medically discharged.
a. Can the nurse prevent the client from leaving?
b. What procedure should the nurse follow if the client refuses to stay at the facility?
2. Personnel at a health care facility follow a team nursing pattern of care, with one member as the team leader.
a. What is team nursing?
b. What are the roles and responsibilities of the team leader?
3. A nurse is caring for a client scheduled for minor surgery who is unusually quiet. The nurse understands that the client is under stress.
a. What can the nurse do when the client is experiencing stress?
b. What stress-reduction techniques can the nurse employ for this client?
4. A nurse is assessing a client who immigrated to the United States years ago and understands English well but does not speak the language fluently. The client does not want an interpreter.
a. How should the nurse communicate with the client during the assessment?
b. Why is it important for the nurse to be patient when communicating with this client?
5. A nurse who works in a large urban clinic assesses clients from various subcultures.
a. What data should the nurse obtain during assessment to provide culturally sensitive care?
b. What variations is a nurse likely to observe when assessing these clients?
Activity K: Consider the following questions. Discuss them with your instructor or peers.
1. A client with a fractured left leg is learning how to use crutches. The nurse has asked the client not to leave the room without assistance. The client ignores this suggestion and falls. How should the nurse handle this situation?
2. A client is unhappy with the lunch served to him at the health care facility. When the nurse arrives to check if the client has eaten, the client pushes away the tray, spilling its contents on the floor. What should the nurse do in this case?
3. A client who is to undergo chemotherapy expresses concern about the side effects of the drug treatment and the effects that the cancer is causing on his family roles. The client mentions to the nurse that he tries to combat stress by sleeping most of the time. What interventions can the nurse suggest to help reduce the client’s stress?
4. A nurse is working at a health care facility where most clients do not speak English. How should the nurse prepare to meet the challenges of this job?
SECTION III: GETTING READY FOR NCLEX
Activity L: Answer the following questions.
1. A nurse at a health care facility has been stealing narcotics for personal use and has been attempting to conceal the theft by altering records of narcotic drug administration. Which of the following would the nurse most likely be charged with in case of legal proceedings?
a. Misdemeanor b. Felony c. Malpractice d. Negligence
2. The nurse has asked a client who is likely to experience orthostatic hypotension to use the nurse’s call light if he needs to use the bathroom. The client refuses to do so. Which of the following actions would be appropriate for the nurse to take to ensure the client’s safety?
a. Raise the side rails of the bed.
b. Obtain a medical order to use a restraint.
c. Threaten to use a restraint.
d. Use a wanderer alarm.
3. A nurse has admitted a client to the health care facility. This same nurse also is responsible for planning the client’s care and evaluating her progress until discharge. What pattern of nursing is being followed?
a. Primary nursing b. Functional nursing c. Nurse-managed care d. Case method
U N I T 2 ● End of Unit Exercises for Chapters 3, 4, 5, and 6 89
90 U N I T 2 ● Integrating Basic Concepts
4. A client who has been diagnosed with cancer refuses to believe this news and tells the nurse that he wants all the diagnostic tests repeated. What kind of coping mechanism is the client exhibiting?
a. Displacement b. Projection c. Sublimation d. Denial
5. A nurse is caring for a client whose right hand had to be amputated following an accident. The client, whose employment involves using a computer keyboard to enter data, may have to look for another job. Which of the following is the highest contributor to stress in this client’s situation?
a. Moving to a different job
b. Adjusting to a change in financial status c. Dealing with a personal injury
d. Changing living conditions
6. The nurse is assigned to care for an Asian American woman. Which of the following is appropriate for the nurse to do when caring for this client?
a. Touch the client’s head gently.
b. Avoid touching the client’s hand.
c. Provide personal care in the presence of family members.
d. Avoid lingering eye contact with the client.
7. When assessing a client who does not speak the same language as the nurse, the nurse seeks the assistance of an interpreter. Which of the following is a characteristic of a skilled interpreter?
a. Explains her role to the client
b. Expresses her views on the client’s statement
c. Informs the client’s family about the client’s condition
d. Translates the client’s statements without conveying the client’s emotions
Fostering
Communication
7 The Nurse–Client Relationship 8 Client Teaching
9 Recording and Reporting
U N I T 3
92
7
Chapter The
Nurse–Client Relationship
W O R D S T O K N O W
affective touch caregiver collaborator communication delegator educator empathy intimate space introductory phase kinesics
nonverbal communication paralanguage
personal space proxemics public space relationship silence social space task-oriented touch terminating phase therapeutic verbal communication touch
verbal communication working phase
L E A R N I N G O B J E C T I V E S
On completion of this chapter, the reader will
● Name four roles that nurses perform in nurse–client relationships.
● Describe the current role expectations for clients.
● List at least five principles that form the basis of the nurse–client relationship.
● Identify the three phases of the nurse–client relationship.
● Differentiate between social communication and therapeutic verbal communication.
● Give five examples of therapeutic and nontherapeutic communication techniques.
● List at least five factors that affect oral communication.
● Describe the four forms of nonverbal communication.
● Differentiate task-related touch from affective touch.
● List at least five situations in which affective touch may be appropriate.
ANintangible factor that helps a client to hold a nurse in high regard is the relation- ship that develops between them. One of the primary keys to establishing and main- taining positive nurse–client relationships is the manner and style of the nurse’s communication. This chapter offers information about techniques for communicat- ing therapeutically, listening empathetically, sharing information, and providing client education, all of which are among the most basic processes within the context of nurse–client relationships.