1. The ambulatory care nurse is discussing
Note the words
preoperative procedures with a Japanese American
client who is scheduled for surgery the following
week. During the discussion, the client continually
smiles and nods the head. How should the nurse
interpret this nonverbal behavior?
1. Reflecting a cultural value
2. An acceptance of the treatment
3. Client agreement to the required procedures
4. Client understanding of the preoperative
procedures
Rationale: Nodding or smiling by a Japanese
American client may reflect only the cultural value
of interpersonal harmony. This nonverbal behavior
may not be an indication of acceptance of the
treatment, agreement with the speaker, or
understanding of the procedure.
Test-Taking Strategy: Eliminate options 2 and 3 first
because they are comparable or alike and are
incorrect. From the remaining options, note that the
client is Japanese American and think about the
characteristics of this group. This will direct you to
option 1. In addition, option 4 is an incorrect
interpretation of the client’s nonverbal behavior.
2. When communicating with a client who speaks a
different language, which best practice should the
nurse implement?
1. Speak loudly and slowly.
2. Arrange for an interpreter to translate.
3. Speak to the client and family together.
4. Stand close to the client and speak loudly.
Rationale: Arranging for an interpreter would be the
best practice when communicating with a client who
speaks a different language. Options 1 and 4 are
inappropriate and ineffective ways to communicate.
Option 3 is inappropriate because it violates
privacy and does not ensure correct translation.
Test-Taking Strategy: Note the strategic word, best,
in the question and note the subject,
communicating with a client of a different culture.
Eliminate option 3 first because this action can
constitute a violation of the client’s right to privacy,
and does not represent best practice. Next,
eliminate options 1 and 4, noting the word loudlyin
these options and because they are nontherapeutic
actions and also are not best practices.
3. The nurse educator is providing in-service
education to the nursing staff regarding
transcultural nursing care; a staff member asks the
nurse educator to provide an example of the
concept of acculturation. The nurse educator
should make which most appropriate response?
1. “A group of individuals identifying as a part of the
Iroquois tribe among Native Americans.”
2. “A person who moves from China to the
United States (U.S.) and learns about and
adapts to the culture in the U.S.”
3. “A group of individuals living in the Azores that
identify autonomously but are a part of the larger
population of Portugal.”
4. “A person who has grown up in the Philippines
and chooses to stay there because of the sense of
belonging to his or her cultural group.”
Rationale: Acculturation is a process of learning a
different culture to adapt to a new or changing
environment. Options 1 and 3 describe a
subculture. Option 4 describes ethnic identity.
Test-Taking Strategy: Note the strategic words,
most appropriate.
Focus on the subject, acculturation.
a person who moves and adapts in the correct
option and relate this to the definition of
acculturation.
4. The nurse is providing discharge instructions to a
Chinese American client regarding prescribed
dietary modifications. During the teaching session,
the client continuously turns away from the nurse.
The nurse should implement which best action?
1. Continue with the instructions, verifying
client understanding.
2. Walk around the client so that the nurse
constantly faces the client.
3. Give the client a dietary booklet and return later
to continue with the instructions.
4. Tell the client about the importance of the
instructions for the maintenance of health care.
Rationale: Most Chinese Americans maintain a
formal distance with others, which is a form of
respect. Many Chinese Americans are
uncomfortable with face-to-face communications,
especially when eye contact is direct. If the client
turns away from the nurse during a conversation,
the best action is to continue with the conversation.
Walking around the client so that the nurse faces
the client is in direct conflict with this
cultural practice. The client may consider it a rude
gesture if the nurse returns later to continue with
the explanation. Telling the client about the
importance of the instructions for the maintenance
of health care may be viewed as degrading.
Test-Taking Strategy: Note the str ategic word,
best. Focus on the subject, the behavior of a
Chinese American client. Eliminate options 3 and 4
first because these actions are nontherapeutic.
To select from the remaining options, think about
the cultural practices of Chinese Americans and
recall that direct eye contact may be uncomfortable
for the client.
5. A critically ill Hispanic client tells the nurse
through an interpreter that she is Roman Catholic
and firmly believes in the rituals and traditions of the
Catholic faith. Based on the client’s statements,
which actions by the nurse demonstrate cultural
sensitivity and spiritual support? Select all that
apply.
1. Ensures that a close kin stays with the client.
2. Makes a referral for a Catholic priest to visit
the client.
3. Removes the crucifix from the wall in the
client’s room.
4. Administers the sacrament of the sick to the
client if death is imminent.
5. Offers to provide a means for praying the
rosary if the client wishes.
6. Reminds the dietary department that meals
served on Fridays during Lent do not contain
meat.
Rationale: In times of illness, a Roman Catholic
client may turn to prayer for spiritual support. This
may include rosary prayers or visits from a priest,
who is the spiritual leader in the Roman Catholic
faith. Close familymembers usuallywant to staywith
a dying family member in order to hear the wishes
of the client, allowing the soul to leave in peace. A
priest, not a nurse, would administer the sacrament
of the sick. Roman Catholics would not ask for the
crucifix to be removed. Members of other religious
groups such as Islam or Judaism may request the Test-Taking Strategy: Focus on the subject, dietary
removal of the crucifix. Dietary rituals are not a kosher laws, and recall that the dairy-meat
concern at this time. Test-Taking Strategy: Focus combination is unacceptable in the Orthodox
on the subject, the Roman Catholic religion. Judaism group. Eliminate option 1 because this
Consider the role of the spiritual leader and family option contains pork roast and milk. Next, eliminate
in the Catholic faith. This will assist in selecting options 2 and 4 because both options contain
options 2 and 5. For the remaining options, recall shellfish.
that the presence of family is a source of support.
9. An Asian American client is experiencing a fever.
6. Which clients have a high risk of obesity and The nurse plans care so that the client can self-treat
diabetes mellitus? Select all that apply. the disorder using which method?
1. Latino American man 1. Prayer
2. Native American man 2. Magnetic therapy
3. Asian American woman 3. Foods considered to be yin
4. Hispanic American man 4. Foods considered to be yang
5. African American woman
Rationale: Because of their health and dietary Rationale: In the Asian American culture, health is
practices, Latino Americans, Native Americans, believed to be a state of physical and spiritual
Hispanic Americans, and African harmony with nature and a balance between
Americans have a high risk of obesity and diabetes positive and negative energy forces (yin and
mellitus. Owing to dietary practices, Asian yang). Yin foods are cold and yang foods are hot.
Americans have a lower risk for obesity and Cold foods are eaten when one has a hot illness
diabetes mellitus. (fever), and hot foods are eaten when one has a
Test-Taking Strategy: Focus on the subject, cold illness. Options 1 and 2 are not health
thosewith a high risk for diabetesmellitus and practices specifically associated with the Asian
obesity.Think about the health and dietary American culture or the yin and yang theory.
practices of each cultural group in the options to Test-Taking Strategy: Focus on the subject, an
answer correctly. Asian American, and the client’s diagnosis, fever.
Remember that cold foods (yin foods) are eaten
7. The nurse is preparing a plan of care for a client, when one has a hot illness, and hot foods (yang
and is asking the client about religious preferences. foods) are eaten when one has a cold illness.
The nurse considers the client’s religious
preferences as being characteristic of a Jehovah’s
Witness if which client statement is made?
1. “I cannot have surgery.”
2. “I cannot have any medicine.”
3. “I believe the soul lives on after death.”
4. “I cannot have any food containing or
prepared with blood.”
Rationale: Among Jehovah’s Witnesses, surgery is
not prohibited, but the administration of blood and
blood products is forbidden. For a Jehovah’s
Witness, administration of medication
is an acceptable practice except if the medication is
derived from blood products. This religious group
believes that the soul cannot live after death.
Jehovah’s Witnesses avoid foods prepared with or
containing blood.
Test-Taking Strategy: Focus on the subject, beliefs
of Jehovah’s Witnesses. Remember that the
administration of blood and any associated blood
products is forbidden among Jehovah’sWitnesses.
Even foods prepared with blood or containing
blood are avoided.

8. Which meal tray should the nurse deliver to a

client of Orthodox Judaism faith who follows a
kosher diet?
1. Pork roast, rice, vegetables, mixed fruit, milk
2. Crab salad on a croissant, vegetables with dip,
potato salad, milk
3. Sweet and sour chicken with rice and
vegetables, mixed fruit, juice
4. Noodles and cream sauce with shrimp and
vegetables, salad, mixed fruit, iced tea
Rationale: Members of Orthodox Judaism adhere to
dietary kosher laws. In this religion, the dairy-meat
combination is unacceptable. Only fish that have
scales and fins are allowed; meats that are allowed
include animals that are vegetable eaters, cloven
hoofed, and ritually slaughtered.