Answer to Question 1
Correct Answer: 1
Rationale 1: In some Asian cultures, only certain elders are permitted to touch the head of others, and children are never patted on the head. Nurses should, therefore, touch a client's head only with permission.
Rationale 2: The nurse should explain the reason for the touching to all children.
Rationale 3: Nurses should always wear gloves for this type of screening process.
Rationale 4: Asking the child to wait until last to avoid embarrassment is not appropriate and does not address the cultural issue.
Answer to Question 2
Correct Answer: 3
Rationale 1: The nursing interview is the nurse's responsibility and should not be postponed for what the nurse perceives as the client's reluctance to communicate.
Rationale 2: The nurse is responsibilityfor the admission interview and it should not be avoided for reasons of discomfort.
Rationale 3: Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. Some cultures are quite comfortable with long periods of silence. Many people value silence and view it as essential to understanding a person's needs or use silence to preserve privacy. 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.
Rationale 4: The admission history can not be postponed in order for the nurse to improve his/her cultural awareness.