Foundations of Nursing in the Community, 3rd Edition Stanhope, Lancaster - Test Bank

Foundations of Nursing in the Community, 3rd Edition Stanhope, Lancaster – Test Bank

 

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Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3^rd Edition

 

Chapter 5: Cultural Influences in Nursing in Community Health

 

Test Bank

 

MULTIPLE CHOICE

 

1. For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patient’s daily prayers. This is an example of which of the following?

a.	Accommodation
b.	Awareness
c.	Brokering
d.	Imposition

 

 

ANS:   A

Cultural accommodation involves including aspects of the patient’s religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important—from the patient’s perspective, possibly more important than medical treatment.

 

DIF:    Cognitive Level: Application             REF:    p. 66

 

2. A nurse states, “The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs.” What does this statement reflect in relation to culture?

a.	Awareness
b.	Blindness
c.	Knowledge
d.	Preservation

 

 

ANS:   B

Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 77

 

3. What should a nurse caring for clients of another culture be sure to do?

a.	Alter personal nonverbal behaviors to reflect the cultural norms of the client.
b.	Keep all behaviors culturally neutral to avoid misinterpretation.
c.	Rely on friendly gestures to communicate caring for the client.
d.	Avoid any pretense of prejudice by treating the client in the same way as any other client.

 

 

ANS:   A

Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 67

 

4. A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client’s history. He stopped doing this around Muslim clients after being told that Muslims were offended when he exposed the sole of his foot (shoe) to their face. What did the nurse exhibit when he changed his behavior?

a.	Cultural accommodation
b.	Cultural imposition
c.	Cultural repatterning
d.	Cultural skill

 

 

ANS:   D

Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the client’s need to not be offended by having the bottom of the nurse’s foot or shoe in view of the client’s face. The nurse using cultural skill makes sure nonverbal communication techniques take into consideration the client’s use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing one’s values on others. Cultural repatterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

 

DIF:    Cognitive Level: Application             REF:    p. 67

 

5. Mexican immigrants who take metamizole (“Mexican aspirin”) for pain may experience life-threatening agranulocytosis. What will a nurse who employs cultural repatterning do?

a.	Complete a cultural assessment to identify any other dangerous medications that the client may be taking.
b.	Put this into perspective by considering that many drugs used in the United States cause agranulocytosis.
c.	Explain the harmful effects of metamizole and recommend an alternative medication for pain.
d.	Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

 

 

ANS:   C

Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them.

 

DIF:    Cognitive Level: Application             REF:    p. 67

 

6. A nurse says, “I’m not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best.” What is such a belief called?

a.	Ethnocentrism
b.	Prejudice
c.	Racism
d.	Stereotyping

 

 

ANS:   A

Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one’s own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, “The way we do it is the only right way to provide this care.”

 

DIF:    Cognitive Level: Application             REF:    p. 77

 

7. A health care worker tells a nurse, “It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them.” What is such a global statement called?

a.	Cultural imposition
b.	Ethnocentrism
c.	Racism
d.	Stereotyping

 

 

ANS:   D

Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food.

 

DIF:    Cognitive Level: Application             REF:    p. 67

 

8. An undocumented immigrant has an on-the-job accident in which he loses an arm. How will the immigrant probably receive health care?

a.	Eligibility for emergency health care
b.	Must have insurance to receive health care
c.	Must pay for services out of pocket
d.	Should file for Workers’ compensation

 

 

ANS:   A

Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. As such, these illegal immigrants are eligible only for emergency medical services.

 

DIF:    Cognitive Level: Application             REF:    p. 69

 

9. Which of the following best describes most Americans’ attitude toward immigrants?

a.	Ambivalent
b.	Strongly negative because immigrants take jobs that native-born Americans could have instead
c.	Strongly positive because immigrants bring useful job skills and often join previous family members already in the United States
d.	Totally against further immigration

 

 

ANS:   A

Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 68

 

10. A nurse wishes to develop cultural competence. What should the nurse attempt to do first?

a.	Complete a survey of all the various ethnicities represented in the nurse’s community.
b.	Consider how the nurse’s own personal beliefs and decisions are reflective of his or her culture.
c.	Invite a family from another culture to join the nurse for an event.
d.	Study the beliefs and traditions of persons living in other cultures.

 

 

ANS:   B

Cultural awareness requires self-examination and an in-depth exploration of one’s own beliefs and values as they influence behavior.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 69

 

11. A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. What should the nurse do?

a.	Attempt communication using an English-Spanish phrase book.
b.	Call the local hospital and arrange a referral.
c.	Emphatically state, “No hablo Español” (I don’t speak Spanish).
d.	Obtain an interpreter to translate.

 

 

ANS:   D

Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client’s language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received.

 

DIF:    Cognitive Level: Application             REF:    p. 71

 

12. A 40-year-old Bosnian Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Assuming several people are available to interpret, who would be the most appropriate choice?

a.	A Bosnian male who is certified as a medical interpreter
b.	A female from the client’s community
c.	A female who does not know the client
d.	The client’s 20-year-old daughter

 

 

ANS:   C

Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpret for females. This client has specifically requested a female provider; therefore one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 79 (How To box)

 

13. At a local hospital, postpartum care policy requires that nurses observe the mother during infant care to assess the mother’s ability to care for the new baby and to promote bonding. A new immigrant mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Otherwise, it is believed that the mother will be unable to care for the child because she will not have healed sufficiently. What will the culturally competent nurse do?

a.	Allow family members to provide the baby’s care and assess the mother’s knowledge of child care through discussion.
b.	Explain the importance of bonding and that all good mothers gladly assume these responsibilities.
c.	Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care.
d.	Explain that she must abide by hospital policy because documentation of the mother’s ability to give the infant care is required for discharge.

 

 

ANS:   A

Culturally competent nursing care focuses on the specific patient, reflects the patient’s individual beliefs and values, and is provided with sensitivity.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 70

 

14. When teaching a nutrition class to a student group with a large Hispanic population, the student health nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. What type of action does the nurse’s approach represent?

a.	Primary prevention
b.	Secondary prevention
c.	Tertiary prevention
d.	Both primary and secondary prevention

 

 

ANS:   A

Primary prevention involves activities such as health teaching to prevent a problem from occurring.

 

DIF:    Cognitive Level: Application             REF:    p. 79 (Levels of Prevention box)

 

15. The nurse practitioner (NP) has just found that an immigrant client is not taking the penicillin prescribed because his illness is “hot” and he believes that penicillin, a “hot” medicine, will not provide balance. By changing the client’s prescription to a different yet equally effective antibiotic, the NP is demonstrating:

a.	Cultural awareness
b.	Cultural brokering
c.	Cultural knowledge
d.	Cultural skill

 

 

ANS:   D

Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioner’s need to prescribe an effective antibiotic.

 

DIF:    Cognitive Level: Application             REF:    p. 67

 

16. A patient known to be Buddhist enters the hospital for some diagnostic tests just before lunch time. The nurse tells the aide passing out lunch trays to give a meal tray to the new patient, since no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. What did the nurse forget?

a.	A physician’s prescription is necessary before any food can be served.
b.	The patient’s Buddhist faith probably requires a vegetarian diet.
c.	The patient may be too frightened about the tests to want to eat very much.
d.	The patient may have diabetes or be allergic to some foods.

 

 

ANS:   B

Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don’t eat meat.

 

DIF:    Cognitive Level: Application             REF:    p. 74

 

17. A client is crying softly and saying “What did I do to deserve this punishment, Lord?” What response by the nurse would be appropriate?

a.	“God doesn’t punish people. You’re sick just because of bad luck.”
b.	“Should I call the hospital chaplain to help you?”
c.	“What can I do to be helpful to you right now?”
d.	“Would you like to confess your sins and repent so this illness will go away?”

 

 

ANS:   C

Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Since the nurse may not be a member of the client’s religious faith group, an open-ended response showing caring is the most appropriate statement.

 

DIF:    Cognitive Level: Application             REF:    p. 77

 

18. A clinic nurse gives detailed information on how to apply for SCHIP to a new mother who moved to the Unites States from Russia about 10 years ago. The nurse’s next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible for COBRA (insurance available after employment is lost) and therefore does not discuss insurance at all. What error is the nurse making?

a.	Covert intentional prejudice
b.	Covert unintentional prejudice
c.	Overt intentional prejudice
d.	Overt unintentional prejudice

 

 

ANS:   C

The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client.

 

DIF:    Cognitive Level: Application             REF:    p. 77 (Box 5-3)

 

19. A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose, although the patient denies taking more than the label indicated. What is the most likely explanation?

a.	The patient was taking more mediation in the hope of getting well faster.
b.	The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication.
c.	The patient truly did not understand and thought the dose being taken was correct.
d.	The patient had an idiosyncratic (unique) response to the medication and should have a smaller dose ordered.

 

 

ANS:   B

For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 74

 

20. A nurse who is explaining to a client why it is important to take medication, states, “The medication takes a couple of weeks to be effective, but then you should feel better.” When the client is next seen, no medication has been purchased. What is the most likely explanation?

a.	The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn’t bother with the drug.
b.	The medication required a trip to the pharmacy, and the client just hadn’t had time to obtain the drug yet.
c.	The medication was too expensive for the client’s family.
d.	The client really hadn’t understood why the medication was important.

 

 

ANS:   A

Although any of the answers given is possible, if we look closely at what the nurse stated, there may have been a cultural disconnect based on time orientation. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes.

 

DIF:    Cognitive Level: Application             REF:    p. 79

 

MULTIPLE RESPONSE

 

1. A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore a cultural assessment should be attempted. What specific questions should the nurse ask? Select all that apply.

a.	“Can you tell me where your family is from?”
b.	“Do you practice a particular religious faith?”
c.	“Have you ever been in an American hospital before? “
d.	“Is there anything special we need to know about your food preferences?”
e.	“What do you think helps you stay healthy?”
f.	“What did the physician tell you is wrong with you?”

 

 

ANS:   A, B, D, E

Cultural assessment requires knowledge about the client’s ethnic background, religious preference, food patterns, and health practices. Questions should be chosen to obtain such information in as courteous a way as possible.

 

DIF:    Cognitive Level: Application             REF:    p. 77-78