Harkreader: Fundamentals of Nursing, 3rd Edition



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Chapter 3: Cultural Context of Practice



MULTIPLE CHOICE

1. Which of the following are not shared by people within an ethnic group?



1.

language and dialect

2.

dietary preferences

3.

values

4.

an internal sense of commonality

ANS: 4


Characteristics shared by ethnic groups include language and dialect, shared traditions, values and symbols, food preferences, and an internal sense of distinctiveness.

DIF: Cognitive Level: Knowledge REF: Page: 3-45

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which of the following is the least effect means of administering culturally competent care?



1.

understanding that each person is a product of experiences, beliefs, and values

2.

projecting personal cultural uniqueness and worldview onto the client

3.

learning about the major characteristics of predominant cultural groups

4.

focusing on culture-specific values, beliefs, and practices

ANS: 2


To administer culturally appropriate care, the nurse must avoid projecting onto the client the nurse’s own cultural uniqueness and world view. The other choices are helpful in administering culturally competent care.

DIF: Cognitive Level: Application REF: Page: 3-47

KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity

3. A culturally competent practitioner has which of the following attributes?



1.

lack of awareness

2.

insensitivity

3.

respect

4.

ability to hold firm to one’s viewpoint

ANS: 3


Culturally competent practitioners have five attributes: awareness, sensitivity, recognition, respect, and the ability to compromise.

DIF: Cognitive Level: Knowledge REF: Page: 3-47

KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity

4. The Giger and Davidhizar transcultural assessment model considers which of the following to be a phenomenon that is present in all cultural groups?



1.

religion

2.

lifestyle

3.

communication

4.

mood

ANS: 3


The six elements of a transcultural assessment are communication, space, social organization, time orientation, environmental control, and biological variations.

DIF: Cognitive Level: Knowledge REF: Page: 3-48

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

5. A nurse is trying to teach a client alternative ways of preparing foods that are consistent with dietary changes needed to maintain health. This nurse is engaged in which of the following modalities of providing culturally sensitive nursing care?



1.

cultural care preservation

2.

cultural care maintenance

3.

cultural care negotiation

4.

cultural care repatterning

ANS: 4


Cultural care repatterning/restructuring involves helping the client change patterns of living that are not beneficial to healthy life patterns. Cultural care preservation/maintenance is helping a client continue cultural practices that have importance to the client. Cultural care accommodation/negotiation involves changing the nurse’s behavior to be more fully understood and accepted by the client.

DIF: Cognitive Level: Comprehension REF: Page: 3-48

KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity

6. The nurse is administering care to a client group that includes individuals from four cultures. In trying to give culturally competent care, the nurse understands that the client who probably requires the least personal space is the:



1.

Canadian.

2.

American.

3.

Latin American.

4.

Briton.

ANS: 3


Personal space is a person’s body and the space around the body. Americans, Canadians, and Britons require considerable personal space. Latin Americans, Japanese, and Arabs need a smaller area of personal space.

DIF: Cognitive Level: Knowledge REF: Page: 3-49

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

7. A person who is more future-oriented would be most likely to:



1.

have difficulty dealing with chronic illness for which a complete cure is not known.

2.

stay future-oriented throughout the life span.

3.

have trouble dealing with present difficulties and inconveniences of illness.

4.

comply with a treatment regimen that has uncertain benefits.

ANS: 1


A future-oriented person has little focus on the difficulties and inconveniences of the present, focusing instead on future goals. The person may have little trouble following a treatment plan as long as its benefits are clear, but may have great difficulty dealing with chronic illnesses for which no complete cure is known. A future-oriented person naturally becomes more present-oriented with age because, as the future life becomes shorter, the present becomes more important.

DIF: Cognitive Level: Analysis REF: Page: 3-50

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

8. A nurse who is aware of the biological variations among cultures would expect that a client with Tay-Sachs disease would most likely be of which of the following cultural heritages?



1.

Jewish

2.

Mexican

3.

Chinese

4.

African

ANS: 1


Genetic variations that produce different health problems in different races are uncommon but do exist. Tay-Sachs disease is more common in people of Jewish ancestry.

DIF: Cognitive Level: Knowledge REF: Page: 3-50

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

9. A nurse would interpret that an individual who states that the health is only acquired by luck is demonstrating a(n):



1.

future orientation.

2.

external locus of control.

3.

environmental control.

4.

internal locus of control.

ANS: 2


Individuals with an external locus of control are more likely to believe that events are primarily caused by chance, fate or luck.

DIF: Cognitive Level: Analysis REF: Page: 3-50

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

10. An acute care nurse communicating with a client from a different culture notes that the client intermittently nods the head and smiles during the conversation. The nurse would promote effective communication with this client by placing which of the following interpretations on this client’s behavior?



1.

The client agrees with the content of the conversation.

2.

The client may not understand, but may be trying to please the nurse.

3.

The client agrees with the plan of care.

4.

The client is willing to do whatever is necessary in order to be discharged.

ANS: 2


Smiles and head nodding may indicate that the client is trying to please the nurse rather than understanding the information.

DIF: Cognitive Level: Analysis REF: Page: 3-51

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

11. An African-American client should be assessed for which one of the following health problems that occurs more frequently and has a higher mortality rate in this cultural group?



1.

multiple sclerosis

2.

thalassemia

3.

hypertension

4.

cystic fibrosis

ANS: 3


Hypertension is common among African-Americans and also has higher mortality in this group. Other diseases common among African-Americans are sickle cell disease, lactose intolerance, cancer, cardiovascular disease, cirrhosis, and diabetes.

DIF: Cognitive Level: Knowledge REF: Page: 3-52

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. When working with Mexican-American clients, a nurse should be aware that this cultural group has which of the following tendencies in the area of communication?



1.

They are direct and confrontational.

2.

They readily engage in self-disclosure.

3.

They use only words, not the other senses, to communicate.

4.

They may use elaborate and indirect communication.

ANS: 4


Mexican-Americans place a high value on diplomacy and tactfulness and communicate in a manner that avoids direct confrontation and arguments, which are considered rude and disrespectful. They use elaborate, often indirect communication. Self-disclosure is avoided with strangers, including health care professionals. Members of this cultural group incorporate the use of senses as well as words, and they are characterized as tactile in their relationships.

DIF: Cognitive Level: Knowledge REF: Page: 3-52

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

13. A nurse asks a Mexican-American client what methods were used to treat an illness before the client sought help at the ambulatory clinic. The nurse is not surprised when the client reports using which of the following forms of treatment for illness, which is the most popular among Mexican-Americans?



1.

herbal teas

2.

massage

3.

prayer

4.

rituals

ANS: 1


The most popular form of treatment by folk healers involves the use of herbs, especially when used as teas. Treatments also include massage, cleansings, diet, rest, prayers, and supernatural rituals.

DIF: Cognitive Level: Application REF: Page: 3-53

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. A hospitalized Chinese-American client prefers eating foods that have a yin quality. The nurse would offer the client which of the following foods?



1.

lamb

2.

oranges

3.

peanuts

4.

beef

ANS: 2


According to principles of Chinese medicine, yang symptoms are treated with foods that have yin qualities, such as oranges, limes, watermelon, and cucumber. Yin symptoms are treated with foods that have yang qualities, such as lamb, beef, chicken, ginger, chili, and peanuts.

DIF: Cognitive Level: Application REF: Page: 3-55

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. A nurse is implementing a plan of care for a Chinese-American client. The nurse should look for which of the following client cues to determine that the client disagrees with the plan of care?



1.

assuming an angry facial expression

2.

refusing to participate in further treatment

3.

losing eye contact with the nurse

4.

staring into the nurse’s eyes

ANS: 3


Chinese-Americans are more likely to express disagreement in a nonverbal way because they hold that it is shameful to openly express disagreement. They may lose eye contact, change subjects, or appear reluctant.

DIF: Cognitive Level: Application REF: Page: 3-54

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

16. A Navajo Indian client died in the hospital while being treated for a severe illness. The nurse caring for the client would expect family and other tribal members to do which of the following after the client’s death?



1.

Refrain from touching the client.

2.

Touch the client’s hand.

3.

Kiss the client’s forehead.

4.

Participate in postmortem care.

ANS: 1


The Navajo culture holds a taboo against touching (1) a dead person or (2) an animal killed by lightning. Consequently, a Navajo client or family member may prefer not to touch articles associated with a dead person or animal.

DIF: Cognitive Level: Application REF: Page: 3-56

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

17. Teaching a family to modify recipes to baking from frying is an example of:



1.

stereotyping.

2.

culture care/preservation/maintenance.

3.

cultural accommodation/negotiation.

4.

cultural care repatterning/restructuring.

ANS: 4


Cultural care repatterning helps the client change patterns of living that are not beneficial to healthy life patterns. Cultural care/preservation/maintenance helps clients continue cultural practices that are important to them. Cultural accommodation/negotiation consists of changing the nurse’s own patterns to be more fully understood and accepted by the client. Stereotyping is the assumption that an attribute present in some members of a group is present in all members.

DIF: Cognitive Level: Knowledge REF: Page: 3-48

KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

18. Which of the following cultures/races is not at risk for diabetes mellitus?



1.

Navajo

2.

Mexican-American

3.

Chinese

4.

African-American

ANS: 3


Of the choices offered, the only culture/race not at risk for diabetes is the Chinese culture. The other options all are at significant risk for the development of diabetes because of either genetic, cultural, or economic risks.

DIF: Cognitive Level: Understanding REF: Page: 3-55

KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

19. What is shaped by the values, beliefs, norms, and practices held in common by its members?



1.

ethnic group

2.

aggregate

3.

society

4.

culture

ANS: 4


A culture is shaped by the values, beliefs, norms and practices. Ethnicity refers to a group of people who are members of the same race or national origin. Aggregates are members of a community who may have a similar characteristic but do not necessarily interact. Society is a group of people in general.

DIF: Cognitive Level: Understanding REF: Page: 3-45

KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

20. When one is seeking to achieve cultural competence, what is the first step one must undertake?

1.

knowledge of other cultures

2.

ability to speak other languages

3.

clarification of one’s own values

4.

attitude of appreciation

ANS: 3


It is important to clarify one’s own values as a prerequisite to caring for clients of differing cultures. Then, an attitude of appreciation and knowledge of other cultures can be effective. An ability to speak other languages is certainly helpful, but the cultural competence can be approached without the personal knowledge of other languages.

DIF: Cognitive Level: Comprehension REF: Page: 3-47

KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

21. When the nurse and patient speak different languages, interpreters are often used to facilitate communication. Suggested interpreters include all EXCEPT which of the following?



1.

telephone interpreter service

2.

client’s family or friend

3.

bilingual staff

4.

volunteer staff or community interpreters

ANS: 2


Although a client’s family member or friend may intend to have the client’s best interests in mind, using such a person as an interpreter is not an acceptable option. A family member of friend may not have enough understanding of the medical terminology or facts to accurately translate, and using such a person may violate the Health Insurance Portability and Accountability Act (HIPAA). The other options are individuals who are trained to translate and have HIPAA training.

DIF: Cognitive Level: Understanding REF: Page: 3-57

KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment



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