Nursing Acceleration Challenge Exam I PN Cultural and Spiritual Considerations in Nursing 6

Question 1

An Orthodox Jewish client dies on the unit after a massive GI bleed. The family is on the way and has asked that the body be handled according to Jewish law. Which nursing action is most appropriate before the family and their burial society arrive?

Accepted Answer

Handle the body as little as possible, leave blood-soaked dressings and items with the body, and wait for the family or rabbi before giving any postmortem care

Answer

In traditional Jewish practice, a burial society (chevra kadisha) performs the ritual washing (tahara). Blood lost near the time of death is considered part of the person and is often buried with the body, so blood-soaked items should not be thrown away. The nurse should handle the body minimally, respectfully, and according to facility policy, and talk with the family or rabbi before doing routine postmortem care. Autopsy is generally discouraged unless the law requires it. Prompt burial matters, but moving the body to the morgue without asking the family ignores their stated wishes.

Question 2

A Muslim client with type 1 diabetes on a basal-bolus insulin regimen says they plan to fast from dawn to sunset during Ramadan. The client knows that people who are ill are exempt, but says fasting is deeply meaningful to them. What is the nurse's best action?

Accepted Answer

Respect the client's choice, work with the provider on adjusting insulin timing and doses for the pre-dawn (suhoor) and sunset (iftar) meals, and teach the client when to break the fast, such as hypoglycemia or a glucose below the set threshold

Answer

Culturally competent care respects the client's autonomy and religious values while reducing risk. Many clients choose to fast even though they qualify for an exemption. The nurse should not decide religious questions for the client or label them nonadherent. Instead, the nurse works with the provider on Ramadan-specific insulin changes, such as adjusting the basal dose and timing boluses to suhoor and iftar. The nurse also teaches clear rules for breaking the fast, such as glucose below about 70 mg/dL, symptoms of hypoglycemia, or hyperglycemia with ketones. Skipping all insulin, even basal insulin, puts a client with type 1 diabetes at risk for DKA.

Question 3

A Jehovah's Witness client who carries a signed 'No Blood' card is scheduled for major surgery. The client asks which treatments the surgical team might be able to offer. Which product is generally left to each Jehovah's Witness's personal conscience rather than being refused outright?

Accepted Answer

Albumin, which is a fraction derived from plasma

Answer

Jehovah's Witnesses generally refuse whole blood and its four primary components: red cells, white cells, platelets, and plasma. That rules out FFP and platelets. They also typically refuse blood that has been stored, including their own predonated blood, because stored blood has left the body. Minor fractions such as albumin, immunoglobulins, and clotting factor concentrates are left to individual conscience. The nurse must ask each client about each product and record the client's specific choices.

Question 4

A nurse is talking about advance directives with an older Navajo (Diné) client who has heart failure. The client becomes quiet and uncomfortable when the nurse asks, 'What should we do if your heart stops?' Which approach best fits this client's possible cultural beliefs?

Accepted Answer

Rephrase in the third person or as a hypothetical, such as 'Some people in a situation like this choose…', because speaking directly about bad outcomes may be believed to make them happen

Answer

In traditional Navajo belief, words have power, and speaking directly about death or a bad outcome may be thought to bring it about. Research on Navajo end-of-life care suggests framing such information in the third person or as a hypothetical. This keeps the client informed and involved without violating that belief. Skipping the conversation denies the client autonomy. Assuming elders hand off decisions is a stereotype. Simply repeating the question ignores the cultural cue.

Question 5

A Spanish-speaking client needs informed consent for a procedure. The nurse offers a certified medical interpreter, but the client firmly refuses and asks that their bilingual adult son interpret. What is the most appropriate nursing action?

Accepted Answer

Respect the client's preference, let the son interpret, document the client's informed refusal of the professional interpreter, and, if facility policy allows, have a qualified interpreter present or on the line to monitor accuracy

Answer

Clients have the right to a qualified interpreter at no cost, and they also have the right to decline one. If a competent adult declines, the nurse documents the offer and the refusal. For high-stakes conversations such as informed consent, best practice and many facility policies call for a qualified interpreter to stay present or available to make sure information is conveyed accurately. Family members may filter or soften information. A flat refusal to proceed ignores the client's autonomy. Unvalidated phone apps do not meet standards for consent discussions.

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

Nursing Acceleration Challenge Exam I PN Cultural and Spiritual Considerations in Nursing 6