A community health nurse is planning a smoking cessation class. Which of the following factors will have the greatest effect on the success of the class?

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.

Choice A reason: Blood pressure screening is not the first thing that the nurse should perform, as it is a physical assessment that can be done later in the visit. Blood pressure screening is important to monitor the client's cardiovascular health and risk of hypertension, but it is not a priority for the initial visit.

Choice B reason: Mental status examination is not the first thing that the nurse should perform, as it is a psychological assessment that can be done later in the visit. Mental status examination is important to evaluate the client's cognitive, emotional, and behavioral functioning and identify any mental health issues, but it is not a priority for the initial visit.

Choice C reason: Review of the neighborhood is the first thing that the nurse should perform, as it is an environmental assessment that can provide valuable information about the client's living conditions, safety, and resources. Review of the neighborhood is important to identify any potential hazards, barriers, or needs that may affect the client's health and well-being, and to plan appropriate interventions and referrals.

Choice D reason: Family history is not the first thing that the nurse should perform, as it is a genetic and social assessment that can be done later in the visit. Family history is important to determine the client's risk of inheriting or developing certain diseases, and to understand the client's family dynamics and support system, but it is not a priority for the initial visit.