Chapter 03: Cultural and Pharmacogenetic Considerations (FREE) Nursing School Test Banks

Chapter 03: Cultural and Pharmacogenetic Considerations
Test Bank

MULTIPLE CHOICE

1. The nurse is performing a pain assessment on a patient of Asian descent. The patient does not describe the pain when asked to do so and looks away from the nurse. What will the nurse do next?
a. Ask the patients family member to evaluate the patients pain.
b. Conclude that the patients pain is minimal.
c. Evaluate the patients non-verbal pain cues.
d. Suspect that the patient is experiencing severe pain.
ANS: C
Patients of Asian descent might speak in soft tones and avoid direct eye contact while being comfortable with long silences. It is not correct to ask family members to evaluate pain. Without assessment of non-verbal cues, the nurse cannot determine whether the pain is minimal or severe.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 23
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

2. The nurse is preparing to discuss long-term care needs with a patient newly diagnosed with a chronic disease. The patient is of Latin American descent. The nurse will plan to take which action when teaching this patient?
a. Discussing long-term outcomes associated with compliance of the prescribed regimen
b. Highlighting various traditional healing practices that will not be effective for this patients care
c. Providing factual information and answering all questions as they arise
d. Providing teaching in increments, allowing periods of silence to allow assimilation of information
ANS: C
The nurse should provide factual information and answer questions. Persons of Latin American descent have less dependence on time schedules and do not tend to have a future orientation. They are not comfortable with periods of silence. Nurses should be receptive to traditional healing practices and seek ways to include those in care when they do not hinder safe and effective care; highlighting practices that wont work may convey a lack of respect for these traditions.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 24
TOP: NURSING PROCESS: Planning MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

3. A Native American patient has just been diagnosed with diabetes mellitus. The nurse preparing a teaching plan for this patient understands that which aspect of the disease and disease management may be most difficult for this patient?
a. Body image changes
b. Management of meal and medication schedules
c. Perception of the disease as punishment from God
d. The sense of dependence on others
ANS: B
Non-European cultural groups such as those of Native American descent have less dependence on time schedules. Disease management will likely focus more on present concerns about alleviating current discomfort and less on measures to promote long-term wellness or treat a chronic illness.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 24
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

4. A patient who is of Filipino descent is admitted to the hospital. The nurse goes to the room to start intravenous fluids and to perform an admission assessment and finds several family members in the room. Which action by the nurse is appropriate?
a. Ask the family to wait in the hallway until the admission tasks are completed.
b. Determine which family member is the family patriarch and address questions to him.
c. Invite family members to assist with appropriate tasks during the admission process.
d. Provide chairs for family members and ask them to stay seated during the admission.
ANS: C
In general, the Filipino culture expects that family members will stay at a patients bedside and participate in his or her care. The nurse should include the family in appropriate tasks. It is not correct to ask the family to wait in the hall or to sit in chairs and not participate. Filipino families do not necessarily depend on family patriarchs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 24
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

5. The nurse is caring for a patient who is a member of the local Native American community. The patient is refusing medications and treatments in spite of repeated attempts to explain the importance of these interventions. Which is an appropriate nursing action?
a. Ask a family member about traditional healing practices that might be better accepted.
b. Enlist the help of a family member to explain the need for the medications and treatments.
c. Find a hospital staff member who is Native American to help provide teaching for this patient.
d. Suggest a Social Work consult to the patients provider.
ANS: A
Members of some cultures may use traditional healers, and this should be accommodated whenever possible. Showing respect for this patients culture will help to establish trust and thus greater cooperation. It is important for the nurse not to make generalizations within and among cultural groups, so asking a family member to describe what this particular patient needs is the better choice. Finding a hospital staff member who is Native American assumes that all Native Americans have the same practices. Deferring to a Social Worker is not necessary. Enlisting a family member to explain the need for the medications is just another way of imposing treatments on this person without respecting their cultural needs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 24
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

6. The nurse is caring for an African-American patient who appears to understand instructions for self-care but does not carry out basic self-care tasks. The nurse understands that the patient may
a. be poorly educated and lack basic comprehension skills.
b. need more time and personal space to assimilate what is taught.
c. require the use of culturally appropriate words and phrases when teaching.
d. view illness as punishment and lack desire to change the outcome.
ANS: C
African Americans may use a common style of speaking. This vernacular English may be quite different in some cases from standard English, so if things are misunderstood, it is possible that vernacular terminology may need to be used. This vernacular English does not mean that patients are poorly educated or uncommunicative. African Americans do not tend to need more space and do not necessarily view illness as punishment.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 23
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

7. The nurse notes that a patient of African American descent who is taking an oral antihypertensive medication continues to have elevated blood pressure three months after beginning the medication regimen. The nurse suspects that the patient may be
a. consuming ethnic foods that interfere with absorption of the drug.
b. discarding the medication.
c. experiencing allergic reactions to the medication.
d. metabolizing the drug differently than expected.
ANS: D
Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African Americans respond poorly to several classes of antihypertensive agents.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 25
TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

8. The nurse is caring for a postoperative patient who is of Asian descent. The patient reports little relief from pain even while taking an opioid analgesic containing codeine and acetaminophen. What does the nurse suspect that this patient is exhibiting?
a. Drug-seeking behavior
b. Heightened pain perception
c. Poor understanding of expected drug effects
d. Rapid metabolism of one of the drugs components
ANS: D
Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. Persons of Asian descent may have a decreased response to some drugs because they are more likely to have higher levels of CYP2D6 enzymes.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 25
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

9. The nurse is caring for an African-American patient who is taking warfarin (Coumadin) to prevent blood clots. The nurse will monitor this patient carefully for which effect?
a. Decreased therapeutic effects
b. Heightened risk for hemorrhage
c. Increased risk of hypersensitivity
d. Potential risk of paradoxical effects
ANS: A
Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African-American patients will tend to have a decreased therapeutic effect from warfarin (Coumadin).

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 26
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural Diversity

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