Chapter 4: Cultural Aspects of Health and Illness Nursing School Test Banks

Chapter 4: Cultural Aspects of Health and Illness

Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a client from another culture. Which action would demonstrate the first step of developing cultural competence?

a.

Avoiding assuming that members of the same culture all share the same beliefs and values

b.

Developing an understanding of his or her own cultural heritage, feelings, and experiences

c.

Becoming bilingual to communicate effectively with the population of clients served

d.

Developing an understanding of the religious beliefs of clients served by the nurse

ANS: B

Becoming culturally competent first requires the nurse to examine his or her feelings and experiences regarding diversity and to start with an understanding of the nurses own heritage. General assumptions about cultural groups are similar to stereotyping and should be avoided. It is difficult to become fluent in many languages, because the area in which the nurse works may serve many different populations. After examining personal views, the nurse will need to learn more about specific cultural differences to develop an appreciation for the values and beliefs of clients and co-workers.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

2. The nurse is developing a teaching plan on cultural sensitivity for colleagues who are caring for clients from other cultures. What action by the nurse might a client of another culture interpret as culturally insensitive?

a.

Making sure that an Arab female client is covered during assessment

b.

Avoiding making direct eye contact with a male American Indian client

c.

Not encouraging a Japanese-American client to express feelings openly

d.

Hugging an Egyptian-American female client who has received bad news

ANS: D

The nurse should avoid physical touch with clients of cultures other than his or her own because touch by strangers may be unacceptable, even in stressful situations. It is always acceptable practice to make sure that clients are completely covered when providing care and carrying out assessment. Although eye contact in American culture is a positive communication technique, it may be viewed as disrespectful in other cultures. If a client is from another culture, it is good practice to research how he or she might respond to a specific intervention before implementation.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 31

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

3. A Mexican-American client is insistent that her family members stay with her in her hospital room while she is recovering from surgery. What will be the priority action of the nurse?

a.

Explain the policy of the hospital regarding visitors.

b.

Ask the Spanish-speaking chaplain to help explain why this is unacceptable.

c.

Arrange for additional beds to accommodate family members overnight stay.

d.

Notify the physician of the clients anxiety and suggest a prescription.

ANS: C

If a client asks that family members stay, the nurse should facilitate this process by making arrangements and notifying administration. Although it is important for visitors to understand hospital policies, it is possible that the administration will be willing to change policies, within reason, to meet client needs. It is always acceptable to arrange for interpreters if there is difficulty communicating with a multicultural client in his or her language. However, in this case, the chaplain does not have to explain why it is unacceptable because the request is within reason. The physician can be notified that the client is upset, but if allowing the family to stay decreases the clients anxiety, then antianxiety medication usually is not necessary.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

4. A nurse is caring for a lesbian client. What is a priority assessment question for this client?

a.

When was your last complete physical examination?

b.

How much alcohol do you consume?

c.

Do you smoke?

d.

Do you use recreational drugs?

ANS: A

Because there is a higher incidence of at-risk behavior in this population, it is important that the nurse find out about health care screening practices. The other questions could be asked at a later date if additional teaching is needed.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Nursing Process (Assessment)

5. The nurse is providing discharge instructions on medications to an older adult client. The client has expressed concern about paying the hospital bills. What will the nurse emphasize on the basis of best cultural practice?

a.

The client should be prepared to demonstrate filling the daily pill planner at the next appointment.

b.

The client should keep a daily diary of side effects experienced from the medications.

c.

The client must adhere to the medication regimen, unless the cost becomes prohibitive.

d.

The client should ask the pharmacist for the generic version of medications to keep costs to a minimum.

ANS: D

Older adults may be less likely to follow the prescribed therapy because of drug costs. The client should be encouraged to adhere to the medication regimen by using generic medications to save money. Filling a daily pill planner and recording side effects of medications are important aspects of discharge planning but are not the priority teaching points because expense is an expressed issue with this client.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Teaching/Learning

6. What can health care agencies do to assist in meeting the cultural goals of Healthy People 2020?

a.

Ensure accurate recording of a clients race and/or ethnicity in the medical record.

b.

Hire physicians and nurses from culturally diverse backgrounds.

c.

Provide magazines written in more than one language in waiting areas of clinics.

d.

Improve access to health care by establishing clinics closer to low-income housing.

ANS: D

A major initiative of Healthy People 2020 consists of promoting assessment of major health risks, reducing disparities in health care, and expanding access to health care in the community. The other actions only demonstrate sensitivity to cultural differences.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Caring

7. The nurse is assessing a new home health client. What observation would be relevant for a cultural assessment?

a.

The client asks the nurse how to obtain assistance with his utility bills.

b.

The clients wife reports that the children are having difficulty in school.

c.

The client tells the nurse that he would like to move into public housing.

d.

The clients wife corrects the husbands response to questions about his parents.

ANS: D

Interaction among family members can give important clues to culture and cultural influence. In many cultures, the husband is the authority of the household and wives do not express opinions or question the validity of the husbands statements. But in this case, the wife seems to have the ability to give constructive criticism. The other responses do not reflect any specific aspects of an individuals beliefs, values, customs, norms, or habits.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

8. The client states, I cannot receive blood transfusions, because it is against my beliefs. I am concerned about having this surgery. What is the nurses best response?

a.

You should allow your health care team to do whatever is needed.

b.

The blood supply in this country is the safest in the world.

c.

There really is nothing unacceptable about blood transfusion.

d.

There are good alternatives to transfusions that we can discuss.

ANS: D

The clients rights and wishes should be respected while accurate information is provided for reassurance. In this case, stating that there are alternatives to transfusions is the best response. The health care provider should not attempt to persuade the client to go against his or her wishes or religious beliefs. Even though the blood supply is safe, the nurse should realize while working with the client that this is not the issue. The nurse should not try to change the clients views or practices.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Religious and Spiritual Influences on Health)

MSC: Integrated Process: Caring

9. A nurse is working with a new group of immigrants and wants to learn more about their culture. Which method of cultural assessment should the nurse perform to gain a long-term understanding of this culture?

a.

Interview a client.

b.

Observe a group.

c.

Participate in the community.

d.

Visit a group of clients.

ANS: C

Participating in a community that has a large number of members from a particular culture provides insight into the particular cultural group as a whole, rather than from an individual point of view. The nurse can passively learn about an individual or a group through interview, observation, and visitation, but active participation in a community can create a long-lasting understanding of the groups ways of life.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

10. The client expresses distress over missing religious services while in the hospital. What is the nurses best action?

a.

Tell the client that he or she shouldnt worry about it right now.

b.

Ask the clients spouse or family member to pray with the client.

c.

Ask the hospitals professional chaplain to talk to the client.

d.

Encourage the client to reschedule procedures for another day.

ANS: C

When the client is experiencing spiritual distress, it is best for the nurse to collaborate with the professional chaplain in managing the clients religious concerns. The clients family may also help ease spiritual distress, but it is hard to plan for this without knowing the familys comfort in open display of religion. The other responses are not therapeutic interventions.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Religious and Spiritual Influences on Health)

MSC: Integrated Process: Caring

11. The nurse is caring for a homeless client after surgery. Which statement by the nurse indicates the best understanding of this special population?

a.

When you receive your prescription, fill the medication at the nearest pharmacy.

b.

To prevent the risk of infection, you need to bathe daily and keep the incision clean.

c.

Tell me about your home situation and access to food and medications.

d.

To help with healing, be sure to eat meals high in protein and low in fat and cholesterol.

ANS: C

The nurse must be aware of the challenges of the homeless client. This individual is not able to easily fill prescriptions because of lack of funds and can be challenged to find shelter in which daily bathing is possible. The diet of the homeless client often is high in saturated fats, sodium, and cholesterol. Asking the client about his or her ability to find food and housing will give the nurse concrete data that can lead to consultation with social services and other needed resources.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Nursing Process (Assessment)

MULTIPLE RESPONSE

1. Which factors are included as part of Purcells domains for assessing cultural groups or persons? (Select all that apply.)

a.

Nutrition and communication

b.

Family roles and organization

c.

Elementary education

d.

Biofeedback

e.

Death rituals and spirituality

f.

Alternative and complementary therapies

ANS: A, B, E, F

The following are part of Purcells domains for assessing cultural groups or persons:

Nutrition

Communication

Family roles and organization

Workforce issues

Biocultural ecology

High-risk behaviors

Overview (such as heritage)

Pregnancy and childbirth practices

Death rituals

Spirituality

Health care practices

Health care practitioners

DIF: Cognitive Level: Comprehension/Understanding REF: Table 4-2, p. 32

TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity)

MSC: Integrated Process: Caring

2. Which statement by the nurse would potentially offend a client in a predominantly Hispanic clinic? (Select all that apply.)

a.

Did you know that your child has the most beautiful eyes that I have ever seen?

b.

So I can best treat you, could you share your beliefs on the hot/cold theory of healing?

c.

Whom do you consider your primary source of healing and treatment?

d.

How can you believe that eating ice cream will stop the bleeding after having a baby?

e.

Why do you say that arthritis in older age is caused by childbirth as a young woman?

ANS: A, D, E

Some people in the Hispanic culture believe that if a person is excessively admired, evil will be imparted to him or her. It is offensive to belittle the values and beliefs of another culture such as mal de ojo, the belief that cold foods will cause bleeding to stop, and that if the vagina is exposed to cold after childbirth, arthritis may occur as an adult. In a therapeutic assessment of a member of the Hispanic culture, the nurse would assess beliefs regarding health care practices and practitioners.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Caring

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