An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

Choice A reason: Determining potential funding sources for the program is an important action, but not the first one. The nurse should first assess the needs of the target population, such as the number of older adults who need the service, their nutritional status, their preferences, and their barriers to access food.

Choice B reason: Inquiring about the availability of volunteers is an important action, but not the first one. The nurse should first assess the needs of the target population, and then plan the resources and personnel needed to implement the program.

Choice C reason: Identifying alternative solutions to address concerns is an important action, but not the first one. The nurse should first assess the needs of the target population, and then identify the possible challenges and solutions to deliver the service effectively and efficiently.

Choice D reason: Performing a needs assessment is the first action that the nurse should take, as it provides the basis for planning, implementing, and evaluating the program. A needs assessment involves collecting and analyzing data about the health status, needs, and resources of the target population and the community. It helps to identify the gaps, priorities, and goals of the program.

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.