A nurse of a community clinic is preparing an educational guide about cultural variances in expression of pain. Which of the following information should the nurse include?

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: Discussing the benefits of eating a well-balanced diet with the client's family is not the first action that the nurse should take. This is an important intervention that can help the client and the family to improve their nutrition and reduce the risk of further complications, but it should be done after the nurse has assessed the family's coping and learning needs.

Choice B reason: Assisting the client and the client's partner with finding an affordable exercise program is not the first action that the nurse should take. This is an important intervention that can help the client and the partner to increase their physical activity and enhance their cardiovascular health, but it should be done after the nurse has evaluated the client's physical and functional status.

Choice C reason: Offering to accompany the client and the client's partner during health care provider visits is not the first action that the nurse should take. This is an important intervention that can help the client and the partner to receive support and guidance during the treatment process, but it should be done after the nurse has established rapport and trust with the family.

Choice D reason: Asking family members about the impact of the disease on relationships within the family is the first action that the nurse should take. This is based on the principle of family-centered care, which states that the nurse should recognize and respect the family as the primary source of support and care for the client. The nurse should ask open-ended questions, listen actively, and express empathy to the family members, and explore how the disease has affected their roles, responsibilities, emotions, and communication.