A client who has diabetes mellitus asks a home health nurse to help her adapt some of her traditional cultural foods to fit her meal plan. Which of the following is the first action the nurse should take when assisting this client?

Choice A reason: Middle Eastern cultural practices do not necessarily include hiding pain from close family members. Some Middle Eastern cultures may express pain openly and seek support from family and friends, while others may prefer to endure pain stoically and privately.

Choice B reason: Native American cultural practices do not always include being outspoken about pain. Some Native American cultures may view pain as a natural part of life and a test of endurance, while others may seek relief from pain through traditional healing methods.

Choice C reason: Puerto Rican cultural practices do not always include the view that outspoken expressions of pain are shameful. Some Puerto Rican cultures may express pain loudly and dramatically, while others may use humor and distraction to cope with pain.

Choice D reason: Asian cultural practices often include suppressing pain to avoid burdening others. Many Asian cultures value harmony, collectivism, and self-control, and may perceive pain as a sign of weakness or dishonor. They may also believe that pain has a spiritual or karmic origin and should be accepted.

Choice A reason: Touching the hair of an African American client during an assessment does not demonstrate accurate cultural knowledge, as it may be considered disrespectful or intrusive. Hair is a sensitive and personal topic for many African Americans, who may have experienced discrimination or stigma based on their hair texture or style¹. The nurse should ask for permission before touching the client's hair and explain the purpose of the assessment.

Choice B reason: Offering to shake hands when meeting an Asian client of the opposite gender does not demonstrate accurate cultural knowledge, as it may be considered inappropriate or offensive. In some Asian cultures, physical contact between men and women who are not related or married is discouraged or prohibited². The nurse should observe the client's body language and follow the client's lead in greeting gestures.

Choice C reason: Maintaining eye contact when interviewing a Native American client does not demonstrate accurate cultural knowledge, as it may be considered rude or aggressive. In some Native American cultures, eye contact is a sign of disrespect or challenge, especially when talking to elders or authority figures³. The nurse should avoid direct eye contact and use a respectful tone of voice when interviewing the client.

Choice D reason: Including both hot and cold food items on a Hispanic client's menu demonstrates accurate cultural knowledge, as it reflects the concept of balance and harmony in Hispanic culture. Many Hispanics believe that health and illness are influenced by the balance between hot and cold forces in the body and the environment⁴. The nurse should respect the client's food preferences and beliefs and provide a variety of food options.