,Chapter 1. Health Maintenance Guideline
sMultiple Choice
Identify the!! choice!!that!!best!! completes!! the!!statement!!or!!answers!!the!!question.
1.!!The!!nurse!!is!!preparing!!to!!teach!!a!!patient!!of!!the!!Asian!!culture!!to!!perform!!postoperati
! ! ! !
ve!!dressing!!changes!!at!!home!!after!!discharge.!!Which!!statement!!made!!by!!the!!nurse!!indicates!!
cultur!!alcompetence?
a. Tell!!me!!how!! you!!feel!!about!! your!!surgery.
b. Asian!!people!! are!!smart,!!so!!this!! should!! be!!easy!!for!! you!!to!!understand.
c. American!!surgeons!!are!!highly!!qualified;!! Im!!sure!! you!!will!!heal!!quickly.
d. Will!!you!!tell!!me!! about!!any!!traditional!!healing!!practices!! that!! you!! would!!like!!to!!use?
2.!!An!!unconscious!!victim!!of!!a!!house!!fire!!is!!brought!!to!!the!!emergency!!department!!by!!
! ! ! !
th!!eparamedics.!!Tied!!to!!the!!right!!wrist!!is!!an!!emblem!!that!!appears!!be!!a!!religious!!talisman.!!
Whic!!h!!action!!should!!the!!nurse!!take?
a. Tape!!it!! in!!place.
b. Do!!nothing!!with!! it.
c. Remove!!it!! and!!lock!!it!!up!!for!!safekeeping.
d. Place!!it!!in!!a!! clothing!!bag!!with!!the!! rest!!of!!the!!patients!! belongings.
3.!! A!!43-year-
! ! ! ! ! ! ! !
old!!patient!!of!!Arab!!descent!!is!!admitted!!to!!the!!hospital.!!To!!comply!!with!!thestate!!laws!!of!!t
he!!organization,!!the!!nurse!!offers!!the!!patient!!a!!Papanicolaou!!smear,!!which!!she!!refuses.!!Wh
ich!!a!!ction!!should!!the!!nurse!!take!!first?
a. Notify!!the!!physician.
b. Report!!the!!refusal!!to!! the!!supervisor.
c. Explain!!the!!rationale!!for!!and!!benefits!!of!!the!!test.
d. Tell!!her!!it!! is!!state!!law!!and!!that!!she!!does!! not!!have!! a!!choice.
4.!!A!!patient!!who!!is!!a!!Jehovahs!!Witness!!has!!severe!!gastrointestinal!!bleeding!!and!!a!!dan
! ! ! ! ! !
gero!!usly!!low!!hemoglobin!!level.!!The!!patient!!is!!fully!!alert!!and!!competent!!and!!refuses!!to!!accep
tthe!!blo!!od!!transfusion!!ordered!!by!!the!!physician.!!Which!!action!!by!!the!!nurse!!is!!most!!appropria
te?
a. Obtain!!a!!court!!order!!to!! give!!the!!blood.
b. Administer!!the!!blood!!while!!the!!patient!!is!!sleeping.
,c. Have!!the!!patients!! spouse!! sign!!the!!consent!!to!!have!!the!!blood!! administered.
d. Ensure!!the!!patient!!understands!!possible!!consequences!! and!!then!!respect!!the!! patients!!wishes.
5.!!A!!patient!!of!!Mexican!!descent!!sees!!a!!curandero!!for!!asthma;!!the!!curandero!!has!!pres
! ! ! ! ! !
cribe!!da!!special!!tea!!to!!be!!taken!!four!!times!!a!!day!!to!!open!!the!!airways.!!How!!should!!the!!nurse!!
respond!!to!!this!!situation?
a. Encourage!!the!!patient!!to!! continue!!drinking!!the!!tea.
b. Encourage!!the!!patient!! to!!drink!!only!!one!!cup!! of!!the!!tea!!each!!day.
c. Ask!!the!!patient!!to!!bring!!in!!the!!tea!!package!!and!! have!!the!!pharmacist!! check!! the!!ingredients.
d. Advise!!the!!patient!!to!!stop!!drinking!!the!!tea!!because!!of!!potential!!interactions!!with!!ot
he!!rmedications.
6.!!The!!nurse!!is!!caring!!for!!a!!young!!adult!!male!!patient!!who!!refuses!!personal!!care!!fr
om!!afemale!!nursing!!assistant.!!Which!!approach!!by!!the!!nurse!!is!!best?
a. Encourage!!the!!patients!! family!!to!!talk!!with!!him!!about!! his!!care.
b. Have!!a!! registered!!nurse!!(RN)!!help!! with!!his!! personal!! care.
c. Assign!!a!!male!!assistant!!to!!help!! with!!his!!personal!! care!!if!!one!!is!! available.
d. Explain!!to!!him!!that!!males!! and!! females!!take!!care!!of!!both!! genders!!in!! this!!hospital.
7.!!The!! nurse!!is!! providing!! medication!! instructions!! to!!a!! 45-year-
old!!patient!!who!!does!!notmaintain!!eye!!contact.!!What!!should!!this!!patients!!behavior!!indicat
e!!t!!o!!the!!nurse?
a. The!!patient!!is!!not!!interested.
b. The!!nurse!!threatens!!the!!patients!! ego.
c. The!!nurse!!is!!in!! a!!hierarchical!! position.
d. The!!patient!!does!!not!!intend!!to!!follow!!the!!instructions.
8.!!The!!nurse!!is!!caring!!for!!a!!patient!!of!!Spanish!!descent!!who!!is!!experiencing!!pain,!!bu
! ! ! ! ! !
t!!do!!esnot!!speak!!English.!!An!!interpreter!!is!!located!!to!!help!!with!!the!!assessment.!!What!!shoul
d!!the!!n!!ursedo!!to!!facilitate!!communication!!with!!this!!patient?
a. Use!!hand!! signals!! to!!determine!!the!!cause!!of!!the!!pain.
b. Ensure!!the!!interpreter!!is!! not!!left!! alone!!with!!the!!patient.
c. Maintain!!eye!!contact!!with!!the!!patient!! and!!the!!interpreter.
d. Use!!only!!physical!! examination!! data;!!do!! not!! rely!!on!! verbal!! communication.
9.!!A!!new!!mother!!of!!Guatemalan!!descent!!brings!!her!!10-
day-!!old!!infant!!to!!a!!clinic!!for!!a!!well-
, baby!!checkup.!! To!! promote!!healing,!! she!!has!! a!!coin!! taped!!to!! the!! infants!!umbilicus.!! What!!should
the!!nurse!!do!!about!! this!!situation?
a. Teach!! the!!mother!! how!! to!! clean!! the!! coin!! daily!!and!! reapply!!it.
b. Explain!!to!!the!!mother!!that!! the!! coin!!is!!not!! necessary!!for!!healing.
c. Tell!!the!!mother!!to!! remove!!the!! coin,!!because!!it!! could!!cause!!an!! infection.
d. Teach!! the!! mother!!how!! to!! apply!!a!! dry!!sterile!!dressing!!in!! place!!of!! the!! coin.
10.!!An!!older!!patient!!who!!follows!!the!!Muslim!!religion!!is!!approaching!!death.!!The!!famil
y!!says!!the!!patients!!bed!!should!!be!!turned!!toward!!the!!opposite!!wall,!!so!!it!!can!!face!!Mecca!!to!!
ensur!!ean!!easier!!passage!!into!!the!!next!!life.!!The!!wall!!they!!want!!the!!bed!!to!!face!!has!!wall!!suct
ion!!and!!oxygen,!!which!!the!!patient!!is!!using.!!Which!!action!!by!!the!!nurse!!is!!appropriate?
a. Get!!permission!!from!!the!! physician!! to!!move!!the!!bed.
b. Rearrange!!the!!furniture!!to!!accommodate!!the!!request.
c. Tell!!them!! you!!will!!move!!the!!bed!! when!!the!!patient!! is!! closer!!to!!death.
d. Tell!!them!!it!!is!!impossible!!because!! of!!the!!short!!tubing!!on!! the!!oxygen!! and!! suction.
11.!!A!!patient!!of!!northern!!European!!descent!!recovering!!from!!surgery!!denies!!postoperati
! ! ! !
!!vepain;!!however,!!vital!!signs!!indicate!!an!!elevated!!pulse!!and!!blood!!pressure.!!The!!patient!!ref
use!!s!!tomove!!in!!bed.!!Which!!nursing!!action!!would!!best!!ensure!!comfort!!and!!timely!!discharge
?
a. Give!!the!!pain!! medicine!!as!!prescribed.
b. Ask!!the!!physician!!to!! prescribe!!the!!analgesics!!around!!the!!clock.
c. Explain!!that!!the!!pain!! medicine!!will!!help!!prevent!! complications.
d. Respect!!the!!patients!! denial!!of!!pain,!!and!!do!!not!! encourage!!the!!pain!! medicine.
! ! ! !12.!!A!!nurse!!who!!emigrated!!from!!China!!begins!!working!!on!!a!!medical!!unit.!!The!!preceptor!
!e!!xplains!!the!!unit!!routines,!!includingBthe!!medication!!administration!!system.!!When!!the!!precept
or!!a!!sks!!if!!the!!nurse!!understands,!!the!!answer!!is!!always:!!Yes,!!I!!understand.!!What!!should!!the!!pr
eceptor!!do!!to!!measure!!the!!nurses!!comprehension?
a. Give!!the!!nurse!!a!!medication!! quiz.
b. Have!!the!!nurse!!repeat!!the!!instructions.
c. Have!!the!!nurse!!demonstrate!!the!!procedures.
d. Ask!!the!! nurse!!which!!information!! is!!hard!!to!! understand.
13.!! A!! 52-year-
old!!from!!Haiti!!is!!hospitalized!!with!!heart!!failure!!and!!wants!!to!!have!!a!!voodoopractitioner!!visit
!!to!!say!!prayers.!!How!!should!!the!!nurse!!respond!!to!!this!!request?
a. Report!!the!!request!!to!!the!!physician!!immediately.
b. Tell!!the!!patient!!that!! this!!is!!not!!permitted!!during!!hospitalization.
c. Tell!!the!!patient!! it!!is!!okay!!for!!the!! voodoo!!practitioner!!to!! say!!prayers.
sMultiple Choice
Identify the!! choice!!that!!best!! completes!! the!!statement!!or!!answers!!the!!question.
1.!!The!!nurse!!is!!preparing!!to!!teach!!a!!patient!!of!!the!!Asian!!culture!!to!!perform!!postoperati
! ! ! !
ve!!dressing!!changes!!at!!home!!after!!discharge.!!Which!!statement!!made!!by!!the!!nurse!!indicates!!
cultur!!alcompetence?
a. Tell!!me!!how!! you!!feel!!about!! your!!surgery.
b. Asian!!people!! are!!smart,!!so!!this!! should!! be!!easy!!for!! you!!to!!understand.
c. American!!surgeons!!are!!highly!!qualified;!! Im!!sure!! you!!will!!heal!!quickly.
d. Will!!you!!tell!!me!! about!!any!!traditional!!healing!!practices!! that!! you!! would!!like!!to!!use?
2.!!An!!unconscious!!victim!!of!!a!!house!!fire!!is!!brought!!to!!the!!emergency!!department!!by!!
! ! ! !
th!!eparamedics.!!Tied!!to!!the!!right!!wrist!!is!!an!!emblem!!that!!appears!!be!!a!!religious!!talisman.!!
Whic!!h!!action!!should!!the!!nurse!!take?
a. Tape!!it!! in!!place.
b. Do!!nothing!!with!! it.
c. Remove!!it!! and!!lock!!it!!up!!for!!safekeeping.
d. Place!!it!!in!!a!! clothing!!bag!!with!!the!! rest!!of!!the!!patients!! belongings.
3.!! A!!43-year-
! ! ! ! ! ! ! !
old!!patient!!of!!Arab!!descent!!is!!admitted!!to!!the!!hospital.!!To!!comply!!with!!thestate!!laws!!of!!t
he!!organization,!!the!!nurse!!offers!!the!!patient!!a!!Papanicolaou!!smear,!!which!!she!!refuses.!!Wh
ich!!a!!ction!!should!!the!!nurse!!take!!first?
a. Notify!!the!!physician.
b. Report!!the!!refusal!!to!! the!!supervisor.
c. Explain!!the!!rationale!!for!!and!!benefits!!of!!the!!test.
d. Tell!!her!!it!! is!!state!!law!!and!!that!!she!!does!! not!!have!! a!!choice.
4.!!A!!patient!!who!!is!!a!!Jehovahs!!Witness!!has!!severe!!gastrointestinal!!bleeding!!and!!a!!dan
! ! ! ! ! !
gero!!usly!!low!!hemoglobin!!level.!!The!!patient!!is!!fully!!alert!!and!!competent!!and!!refuses!!to!!accep
tthe!!blo!!od!!transfusion!!ordered!!by!!the!!physician.!!Which!!action!!by!!the!!nurse!!is!!most!!appropria
te?
a. Obtain!!a!!court!!order!!to!! give!!the!!blood.
b. Administer!!the!!blood!!while!!the!!patient!!is!!sleeping.
,c. Have!!the!!patients!! spouse!! sign!!the!!consent!!to!!have!!the!!blood!! administered.
d. Ensure!!the!!patient!!understands!!possible!!consequences!! and!!then!!respect!!the!! patients!!wishes.
5.!!A!!patient!!of!!Mexican!!descent!!sees!!a!!curandero!!for!!asthma;!!the!!curandero!!has!!pres
! ! ! ! ! !
cribe!!da!!special!!tea!!to!!be!!taken!!four!!times!!a!!day!!to!!open!!the!!airways.!!How!!should!!the!!nurse!!
respond!!to!!this!!situation?
a. Encourage!!the!!patient!!to!! continue!!drinking!!the!!tea.
b. Encourage!!the!!patient!! to!!drink!!only!!one!!cup!! of!!the!!tea!!each!!day.
c. Ask!!the!!patient!!to!!bring!!in!!the!!tea!!package!!and!! have!!the!!pharmacist!! check!! the!!ingredients.
d. Advise!!the!!patient!!to!!stop!!drinking!!the!!tea!!because!!of!!potential!!interactions!!with!!ot
he!!rmedications.
6.!!The!!nurse!!is!!caring!!for!!a!!young!!adult!!male!!patient!!who!!refuses!!personal!!care!!fr
om!!afemale!!nursing!!assistant.!!Which!!approach!!by!!the!!nurse!!is!!best?
a. Encourage!!the!!patients!! family!!to!!talk!!with!!him!!about!! his!!care.
b. Have!!a!! registered!!nurse!!(RN)!!help!! with!!his!! personal!! care.
c. Assign!!a!!male!!assistant!!to!!help!! with!!his!!personal!! care!!if!!one!!is!! available.
d. Explain!!to!!him!!that!!males!! and!! females!!take!!care!!of!!both!! genders!!in!! this!!hospital.
7.!!The!! nurse!!is!! providing!! medication!! instructions!! to!!a!! 45-year-
old!!patient!!who!!does!!notmaintain!!eye!!contact.!!What!!should!!this!!patients!!behavior!!indicat
e!!t!!o!!the!!nurse?
a. The!!patient!!is!!not!!interested.
b. The!!nurse!!threatens!!the!!patients!! ego.
c. The!!nurse!!is!!in!! a!!hierarchical!! position.
d. The!!patient!!does!!not!!intend!!to!!follow!!the!!instructions.
8.!!The!!nurse!!is!!caring!!for!!a!!patient!!of!!Spanish!!descent!!who!!is!!experiencing!!pain,!!bu
! ! ! ! ! !
t!!do!!esnot!!speak!!English.!!An!!interpreter!!is!!located!!to!!help!!with!!the!!assessment.!!What!!shoul
d!!the!!n!!ursedo!!to!!facilitate!!communication!!with!!this!!patient?
a. Use!!hand!! signals!! to!!determine!!the!!cause!!of!!the!!pain.
b. Ensure!!the!!interpreter!!is!! not!!left!! alone!!with!!the!!patient.
c. Maintain!!eye!!contact!!with!!the!!patient!! and!!the!!interpreter.
d. Use!!only!!physical!! examination!! data;!!do!! not!! rely!!on!! verbal!! communication.
9.!!A!!new!!mother!!of!!Guatemalan!!descent!!brings!!her!!10-
day-!!old!!infant!!to!!a!!clinic!!for!!a!!well-
, baby!!checkup.!! To!! promote!!healing,!! she!!has!! a!!coin!! taped!!to!! the!! infants!!umbilicus.!! What!!should
the!!nurse!!do!!about!! this!!situation?
a. Teach!! the!!mother!! how!! to!! clean!! the!! coin!! daily!!and!! reapply!!it.
b. Explain!!to!!the!!mother!!that!! the!! coin!!is!!not!! necessary!!for!!healing.
c. Tell!!the!!mother!!to!! remove!!the!! coin,!!because!!it!! could!!cause!!an!! infection.
d. Teach!! the!! mother!!how!! to!! apply!!a!! dry!!sterile!!dressing!!in!! place!!of!! the!! coin.
10.!!An!!older!!patient!!who!!follows!!the!!Muslim!!religion!!is!!approaching!!death.!!The!!famil
y!!says!!the!!patients!!bed!!should!!be!!turned!!toward!!the!!opposite!!wall,!!so!!it!!can!!face!!Mecca!!to!!
ensur!!ean!!easier!!passage!!into!!the!!next!!life.!!The!!wall!!they!!want!!the!!bed!!to!!face!!has!!wall!!suct
ion!!and!!oxygen,!!which!!the!!patient!!is!!using.!!Which!!action!!by!!the!!nurse!!is!!appropriate?
a. Get!!permission!!from!!the!! physician!! to!!move!!the!!bed.
b. Rearrange!!the!!furniture!!to!!accommodate!!the!!request.
c. Tell!!them!! you!!will!!move!!the!!bed!! when!!the!!patient!! is!! closer!!to!!death.
d. Tell!!them!!it!!is!!impossible!!because!! of!!the!!short!!tubing!!on!! the!!oxygen!! and!! suction.
11.!!A!!patient!!of!!northern!!European!!descent!!recovering!!from!!surgery!!denies!!postoperati
! ! ! !
!!vepain;!!however,!!vital!!signs!!indicate!!an!!elevated!!pulse!!and!!blood!!pressure.!!The!!patient!!ref
use!!s!!tomove!!in!!bed.!!Which!!nursing!!action!!would!!best!!ensure!!comfort!!and!!timely!!discharge
?
a. Give!!the!!pain!! medicine!!as!!prescribed.
b. Ask!!the!!physician!!to!! prescribe!!the!!analgesics!!around!!the!!clock.
c. Explain!!that!!the!!pain!! medicine!!will!!help!!prevent!! complications.
d. Respect!!the!!patients!! denial!!of!!pain,!!and!!do!!not!! encourage!!the!!pain!! medicine.
! ! ! !12.!!A!!nurse!!who!!emigrated!!from!!China!!begins!!working!!on!!a!!medical!!unit.!!The!!preceptor!
!e!!xplains!!the!!unit!!routines,!!includingBthe!!medication!!administration!!system.!!When!!the!!precept
or!!a!!sks!!if!!the!!nurse!!understands,!!the!!answer!!is!!always:!!Yes,!!I!!understand.!!What!!should!!the!!pr
eceptor!!do!!to!!measure!!the!!nurses!!comprehension?
a. Give!!the!!nurse!!a!!medication!! quiz.
b. Have!!the!!nurse!!repeat!!the!!instructions.
c. Have!!the!!nurse!!demonstrate!!the!!procedures.
d. Ask!!the!! nurse!!which!!information!! is!!hard!!to!! understand.
13.!! A!! 52-year-
old!!from!!Haiti!!is!!hospitalized!!with!!heart!!failure!!and!!wants!!to!!have!!a!!voodoopractitioner!!visit
!!to!!say!!prayers.!!How!!should!!the!!nurse!!respond!!to!!this!!request?
a. Report!!the!!request!!to!!the!!physician!!immediately.
b. Tell!!the!!patient!!that!! this!!is!!not!!permitted!!during!!hospitalization.
c. Tell!!the!!patient!! it!!is!!okay!!for!!the!! voodoo!!practitioner!!to!! say!!prayers.
