NUR 155 • EXAM 4
90% TARGET • ADHD-FOCUSED MASTER GUIDE
Culture & Ethnicity • Medication Administration • Pain Management •
Death & Loss
HOW TO USE THIS GUIDE
1) Scan the purple “DO NOT MISS” boxes. 2) Cover the right side of charts and recall aloud. 3)
Redraw each concept map from memory. 4) Do the 30 questions without peeking. 5) Review
only missed concepts.
EXAM MINDSET
For “first / priority / best” questions: SAFETY → ASSESS before acting (unless immediate life
threat) → least invasive → patient-centered → reassess.
,THE 4-UNIT BIG PICTURE
Topic The nurse is mainly trying to… Exam trigger
Individualize care without ASK preferences; use interpreter;
Culture & Ethnicity
assumptions adapt safely
Verify order/MAR/client; assess;
Medication Administration Prevent medication harm
administer; evaluate
Patient report is central; watch
Pain Management Believe, assess, treat, reassess
opioid safety
Protect comfort, dignity, choices, Presence, symptom relief, advance
Death & Loss
family care wishes
ONE SENTENCE TO REMEMBER
Culture = ASK. Meds = VERIFY. Pain = BELIEVE + REASSESS. Death = COMFORT +
PRESENCE.
, 1 • CULTURE & ETHNICITY
DO NOT MISS
Never stereotype. Assess the INDIVIDUAL patient’s beliefs, language, family roles, health
practices, food, spirituality, time orientation, touch/personal space, and preferred care.
Term Few-word meaning Exam clue
How a person lives/interprets
Culture Learned/shared beliefs + practices
health
Identification with
Ethnicity Customs, beliefs, language
racial/national/cultural group
Culture passed generation →
Enculturation Learned from family/community
generation
Exchange after contact between
Acculturation Adopts some features
groups
Assimilation Blends/merges into another group Greater merging
Diffusion Borrowing traits between cultures Trait moves across groups
Ethnocentrism Own culture viewed as superior Judging others by own standards
Cultural competence = nursing process
ADPIE What you do
Ask, observe, use a qualified interpreter; assess
A • Assess
beliefs/preferences.
Identify barriers affecting health
D • Diagnose
management/communication.
P • Plan Make care culturally congruent + safe.
Maintain, accommodate/negotiate, or
I • Implement
repattern/restructure.
Did the plan work for THIS patient? Reassess
E • Evaluate
understanding/adherence.
LEININGER vs GIGER & DAVIDHIZAR
LEININGER = culturally congruent CARE + Sunrise Model + care decisions.
GIGER/DAVIDHIZAR = ASSESSMENT through 6 cultural phenomena.
Giger & Davidhizar 6 Ask about…
Communication Language, meaning, verbal/nonverbal style
Space Touch, distance, privacy
Social organization Family roles, religion, support, decision-makers
Past/present/future orientation; punctuality
Time
expectations
Health beliefs, home remedies, control over
Environmental control
nature/health
Family disease patterns, food, physical/biologic
Biologic variations
differences
LEININGER CARE ACTIONS
MAINTENANCE = support a safe cultural practice. ACCOMMODATION/NEGOTIATION =
adapt/compromise. REPATTERNING/RESTRUCTURING = help change a harmful practice while
respecting values.
LANGUAGE SAFETY
Use electronic/live qualified interpretation when language differs. Verify that meaning was
understood. Do not assume eye contact, touch, family roles, or pain expression mean the same
thing across patients.
90% TARGET • ADHD-FOCUSED MASTER GUIDE
Culture & Ethnicity • Medication Administration • Pain Management •
Death & Loss
HOW TO USE THIS GUIDE
1) Scan the purple “DO NOT MISS” boxes. 2) Cover the right side of charts and recall aloud. 3)
Redraw each concept map from memory. 4) Do the 30 questions without peeking. 5) Review
only missed concepts.
EXAM MINDSET
For “first / priority / best” questions: SAFETY → ASSESS before acting (unless immediate life
threat) → least invasive → patient-centered → reassess.
,THE 4-UNIT BIG PICTURE
Topic The nurse is mainly trying to… Exam trigger
Individualize care without ASK preferences; use interpreter;
Culture & Ethnicity
assumptions adapt safely
Verify order/MAR/client; assess;
Medication Administration Prevent medication harm
administer; evaluate
Patient report is central; watch
Pain Management Believe, assess, treat, reassess
opioid safety
Protect comfort, dignity, choices, Presence, symptom relief, advance
Death & Loss
family care wishes
ONE SENTENCE TO REMEMBER
Culture = ASK. Meds = VERIFY. Pain = BELIEVE + REASSESS. Death = COMFORT +
PRESENCE.
, 1 • CULTURE & ETHNICITY
DO NOT MISS
Never stereotype. Assess the INDIVIDUAL patient’s beliefs, language, family roles, health
practices, food, spirituality, time orientation, touch/personal space, and preferred care.
Term Few-word meaning Exam clue
How a person lives/interprets
Culture Learned/shared beliefs + practices
health
Identification with
Ethnicity Customs, beliefs, language
racial/national/cultural group
Culture passed generation →
Enculturation Learned from family/community
generation
Exchange after contact between
Acculturation Adopts some features
groups
Assimilation Blends/merges into another group Greater merging
Diffusion Borrowing traits between cultures Trait moves across groups
Ethnocentrism Own culture viewed as superior Judging others by own standards
Cultural competence = nursing process
ADPIE What you do
Ask, observe, use a qualified interpreter; assess
A • Assess
beliefs/preferences.
Identify barriers affecting health
D • Diagnose
management/communication.
P • Plan Make care culturally congruent + safe.
Maintain, accommodate/negotiate, or
I • Implement
repattern/restructure.
Did the plan work for THIS patient? Reassess
E • Evaluate
understanding/adherence.
LEININGER vs GIGER & DAVIDHIZAR
LEININGER = culturally congruent CARE + Sunrise Model + care decisions.
GIGER/DAVIDHIZAR = ASSESSMENT through 6 cultural phenomena.
Giger & Davidhizar 6 Ask about…
Communication Language, meaning, verbal/nonverbal style
Space Touch, distance, privacy
Social organization Family roles, religion, support, decision-makers
Past/present/future orientation; punctuality
Time
expectations
Health beliefs, home remedies, control over
Environmental control
nature/health
Family disease patterns, food, physical/biologic
Biologic variations
differences
LEININGER CARE ACTIONS
MAINTENANCE = support a safe cultural practice. ACCOMMODATION/NEGOTIATION =
adapt/compromise. REPATTERNING/RESTRUCTURING = help change a harmful practice while
respecting values.
LANGUAGE SAFETY
Use electronic/live qualified interpretation when language differs. Verify that meaning was
understood. Do not assume eye contact, touch, family roles, or pain expression mean the same
thing across patients.
