Transcultural Nursing Test Bank PDF

lOMoARcPSD|47175070 Ch 07 - Test bank Medical Surgical 1 (Southeastern University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Norman Dominic Ebro (normandominicebr...

lOMoARcPSD|47175070 Ch 07 - Test bank Medical Surgical 1 (Southeastern University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 124 Chapter 07: Overview of Transcultural Nursing 1. In a small, rural hospital the nurse is caring for a patient who speaks a language other than English. The nurse needs to use an interpreter to communicate but the hospital does not have access to an interpreter who speaks the patients language. When choosing another individual to interpret for this patient, what characteristic should the nurse prioritize? A) Interpreter should recognize the need to speak in a loud voice. B) Interpreter should be able to conduct the conversation quickly to avoid misinterpretation. C) Interpreter should be fluent in several dialects of the patients language. D) Interpreter should know that repetition must be avoided while interpreting. Ans: C Feedback: Cultural needs should be considered when choosing an interpreter; for instance, fluency in varied dialects is beneficial. In choosing an interpreter, you do not want one who speaks in an excessively loud voice, conducts the conversation too quickly, or avoids repetition. 2. You are a community health nurse who provides care to a group of Hispanic people living in an area that is predominantly populated by Caucasian people. How would you characterize the Hispanic people in this community? A) An underclass B) A subgroup C) A minority D) An exception Ans: C Feedback: The term minority refers to a group of people whose physical and cultural characteristics differ from the majority of people in a society. There are four generally identified minority groups: Blacks/African Americans, Hispanics, Asian/Pacific Islanders, and Native Americans. Such groups are not referred to as exceptions or underclasses. A subgroup is a division of a group that is in some way distinguished from the larger group. Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 125 3. A nurse is caring for an elderly woman who predominantly identifies with an East Asian culture. How can the nurse best demonstrate an awareness of culturally congruent care? A) Maintain eye contact at all times. B) Try to speak the patients native language. C) Use touch when communicating. D) Establish effective communication. Ans: D Feedback: Establishment of an environment of culturally congruent care and respect begins with effective communication, which occurs not only through words, but also through body language and other cues, such as voice, tone, and loudness. Not all cultures are comfortable with eye contact. Unless you are fluent in the patients native language, trying to communicate in that language would not be effective communication. Not all cultures incorporate touch while communicating. 4. Most nurses have been taught to maintain direct eye contact when communicating with patients. However, some cultural groups do not usually value direct eye contact when communicating with the nurse. Which cultural group would most likely consider the direct eye contact impolite? A) African Americans B) Hispanics C) Canadians D) Native Americans Ans: D Feedback: Eye contact is a culturally determined behavior. Although most nurses have been taught to maintain eye contact when speaking with patients, some people from certain cultural backgrounds may interpret this behavior differently. For example, some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians may consider direct eye contact impolite or aggressive, and they may avert their own eyes when talking with nurses and others whom they perceive to be in positions of authority. 5. An emergency department nurse is preparing to inspect and palpate the head and scalp of an older adult who experienced a fall. A member of which group would most likely consider this examination as a violation of norms? Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 126 A) Jewish B) Asian American C) Islamic D) African American Ans: B Feedback: For many Asian Americans, it is impolite to touch the patients head because the spirit is believed to reside in the head. Therefore, assessment of the head or evaluation of a head injury requires permission of the patient, or a family member if the patient is not able to give permission. This is not the case with the other listed groups. 6. The nurse is helping a patient choose her menu options for the following day. The nurse reads out the option of ham with scalloped potatoes and the patient states that her religion does not allow this. Which of the following is most likely the patients religion? A) Roman Catholicism B) Buddhism C) Islam D) Mormonism Ans: C Feedback: Many Islamic people abstain from eating pork. Members of other religions also proscribe the consumption of meat in general, or pork in particular, but the other listed religions are not among these. 7. The nurse is preparing a discharge teaching session with an Asian patient to evaluate the patients ability to change a dressing. The patient speaks and understands minimal English. What would be the best way to promote understanding during the teaching session? A) Ask the patient to repeat the instructions carefully. B) Write the procedure out for the patient in simple language. Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 127 C) Use an interpreter during the teaching session. D) Have the patient demonstrate the dressing change. Ans: C Feedback: Policies that promote culturally competent care establish flexible regulations pertaining to visitors (number, frequency, and length of visits), provide translation services for nonEnglish-speaking patients, and train staff to provide care for patients with different cultural values. Writing instructions, having the patient demonstrate the procedure, and asking the patient to repeat instructions do not adequately compensate for the communication barrier that exists. 8. You are the nurse caring for a patient who is a recent immigrant to the United States from Mexico. Which of the following variables would you prioritize when performing an assessment of the patients cultural beliefs? A) Patients previous medical history B) Patients marital status C) Patients age D) Patients communication style Ans: D Feedback: Assessment of a patients culture should include the patients country of origin, language (communication style), food preferences or restrictions, health maintenance practices, and religious preferences and practices. This aspect of assessment does not explicitly include the patients support systems, marital status, or age, though each of these parameters would be assessed at different points. 9. You are caring for a patient who is terminally ill whose family has requested to hold a spiritual ceremony during which they will be using incense. What would be the best intervention you could make on behalf of this patient? A) Discourage the use of incense in the hospital. B) Ask the family to have the ceremony off the unit. C) Arrange for the ceremony to occur after notifying all departments affected. D) Encourage the family to conduct the ceremony elsewhere because it may affect other patients in Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 128 the unit. Ans: C Feedback: Culturally competent policies are developed to promote an environment in which the traditional healing, spiritual, and religious practices of patients are respected and encouraged and to recognize the special dietary practices of patients from selected cultural groups. To promote spirituality and transcultural nursing, the nurse should make or help to make the arrangements. The nurse should not attempt to dissuade the family or to relegate the ceremony to a site outside the hospital. 10. A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects. The nurses behavior is an example of what? A) Acculturation B) Cultural blindness C) Cultural imposition D) Cultural taboos Ans: C Feedback: The nurses behavior is an example of cultural imposition, defined as the tendency to impose ones cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. 11. An infant with a diagnosis of pyelonephritis is receiving care on the pediatric unit and the nurses review of the childs electronic health record reveals that the infant has not received any of her scheduled immunizations. The mother informs the nurse that immunizations are against her cultural beliefs, and she does not want her child to receive immunizations. In this scenario, what do the mothers views on immunizations represent? A) Acculturation B) Cultural blindness Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 129 C) A cultural imposition D) A cultural taboo Ans: D Feedback: Immunizations in this scenario are a cultural taboo. Cultural taboos are defined as activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is defined as the tendency to impose ones cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. 12. In planning the nursing care of a patient who lives with chronic pain, the nurse has included the intervention of therapeutic touch. When categorizing this particular complementary therapy, the nurse should identify it as which of the following? A) A biologically based therapy B) A mind-body intervention C) A manipulative and body-based method therapy D) An energy therapy Ans: D Feedback: Therapeutic touch is an example of an energy therapy. Biologically based therapies include herbal therapies, special diet therapies, orthomolecular therapies, and biologic therapies. Mind-body interventions include meditation, dance, music, art therapy, prayer, and mental healing. Manipulative and body-based methods include chiropractic, massage therapy, osteopathic manipulation, and reflexology. The other options are incorrect because they are not examples of energy therapy. 13. You are admitting a patient who is a recent immigrant from China and who has a diagnosis of adenocarcinoma. During the patients admission assessment, the patient speaks of her beliefs related to health care and indirectly references the yin/yang theory. Based on her cancer diagnosis and her yin/yang beliefs, which meal will the patient most likely order for lunch? A) Chicken noodle soup with crackers, fruit crisp, and hot tea B) Turkey sandwich, small tossed salad, and iced tea Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 130 C) Chefs salad, bread, and water D) Fruit smoothie and granola bar Ans: A Feedback: Foods are classified as cold (yin) and hot (yang) in the naturalistic or holistic perspective. In this theory, foods are transformed into yin and yang energy when metabolized by the body. Hot foods are eaten when a person has a cold illness such a cancer, headache, stomach cramps, and a cold. Based on this information, the patient would select chicken noodle soup with crackers, fruit crisp, and hot tea as these are hot foods. The other options are cold foods and are eaten when a patient has a hot illness such as a fever, rash, sore throat, ulcer, or infection. 14. The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes to the unit. During the initial assessment, the patient informs the nurse that he has been seeking assistance and care from the shaman in his community. The nurse recognizes that the patients blood pressure and his blood sugar level are elevated upon admission. What is the nurses best response to the patients indication that his care provider is a shaman? A) Thank you for providing the information about the shaman, but we will keep that information and approach separate from your current hospitalization. B) It seems that the care provided by your shaman is not adequately managing your hypertension and diabetes, so we will try researched medical approaches. C) Dont worry about insulting your shaman, as he will understand his approach to your hypertension and diabetes was not working after your doctor tells him how sick you were in the hospital. D) I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may lower your blood pressure and blood sugar levels. Ans: D Feedback: Native American patients may seek assistance from a shaman or medicine man or woman. The nurses best approach is not to disregard the patients belief in folk healers or try to undermine trust in the healers. Nurses should make an effort to accommodate the patients beliefs while also advocating the treatment proposed by health science. The nurses best response incorporating these strategies is, I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may improve your blood pressure and blood sugar levels. 15. The nurse is providing care for an older adult patient who has a diagnosis of shingles. The nurse is aware that this health problem is attributable to the varicella zoster virus. This belief is an example of which paradigm explaining the cause of disease and illness? A) Biomedical Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 131 B) Naturalistic C) Holistic D) Factual Ans: A Feedback: The biomedical or scientific perspective assumes that all events in life have a cause and effect and that all of reality can be observed and measured. One example of the biomedical or scientific view is the bacterial or viral explanation of communicable diseases. The naturalistic or holistic view states that forces of nature must be kept in natural balance or harmony. Factual is not a recognized category of beliefs. 16. In your role as a community health nurse, you are focusing your current health promotion efforts on diseases that are disproportionately represented among ethnic and racial minorities. Which of the following diseases would you likely address? Select all that apply. A) Human immunodeficiency virus (HIV) B) Cancer C) Heart disease D) Chronic obstructive pulmonary disease (COPD) E) Alzheimers disease Ans: A, B, C Feedback: Ethnic and racial minorities are disproportionately burdened with cancer, heart disease, diabetes, human immunodeficiency virus (HIV), infection/acquired immunodeficiency syndrome (AIDS), and other conditions. COPD and Alzheimers disease are incorrect because health care disparities have not been noted with these two diseases. 17. Prior to planning health promotion interventions in your local community, you are appraising the key health care indicators in your region and comparing them with those in the nation as a whole. What do these key indicators reveal about the United States? A) A significant gap in health status between the overall population and people of specific ethnic backgrounds Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 132 B) A significant gap in health care delivery between the overall population and subgroups of the minority populations C) A significant gap in health status between the Hispanic population and the Native American population D) A significant gap in health care delivery between the Asian American population and the Pacific Islander population Ans: A Feedback: Key health indicators in the United States reveal a significant gap in health status between the overall American population and people of specific ethnic backgrounds. Option B is incorrect because key health care indicators do not show a gap in health care delivery between the overall population and subgroups of minority populations; options C and D are incorrect because these ethnic populations are not singled out in these ways. 18. You are planning an educational inservice for your nursing colleagues with the goal of fostering culturally competent care. What outcome should you prioritize when planning this education? A) Participants will acknowledge and adapt to diversity among their colleagues. B) Participants will develop insight into the characteristics of their own culture. C) Participants will provide equal care to all patients, regardless of their background. D) Participants will evaluate their colleagues levels of cultural awareness. Ans: A Feedback: The concept of culturally competent care applies to health care institutions, which must develop culturally sensitive policies and provide a climate that fosters the provision of culturally competent care by nurses. Nurses must learn to acknowledge and adapt to diversity among their colleagues in the workplace. This is not necessarily dependent on nurses examining their own cultures. Because patients needs vary widely, care is not equal. Evaluating cultural awareness in others does not necessarily enhance ones own cultural competence. 19. The nurse assessing health disparities in the community is focusing on disparities that exist apart from those between ethnic groups. In which of the following groups are these disparities most evident? A) Urban men Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 133 B) People with disabilities C) People who are single D) Middle-aged adults Ans: B Feedback: Health disparities are noted among women, gays and lesbians, and people with disabilities. Specific health disparities have not been found among men, the middle-aged, or single people. 20. You are performing a cultural nursing assessment of a newly admitted patient of Cuban descent. What would you include in your assessment? Select all that apply. A) Family structure B) Subgroups C) Cultural beliefs D) Health practices E) Values Ans: A, C, D, E Feedback: Cultural nursing assessment refers to a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. Subgroups are not a specific focus of this assessment. 21. The quality improvement team at a large, urban hospital has recognized the need to better integrate the principles of transcultural nursing into patient care. When explaining the concept of transcultural nursing to uninitiated nurses, how should the team members describe it? A) Transcultural nursing is the comparative analysis of the health benefits and risks of recognizable ethnic groups. B) Transcultural nursing refers to research-focused practice that focuses on patient-centered, culturally, competent nursing. C) Transcultural nursing refers to a systematic and evidence-based effort to improve health outcomes Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 134 in patients born outside the United States. D) Transcultural nursing is a term used to describe interventions that seek to address language barriers in nursing practice. Ans: B Feedback: Transcultural nursing, a term sometimes used interchangeably with cross-cultural, intercultural, or multicultural nursing, refers to research-focused practice that focuses on patient-centered, culturally competent nursing. It is not limited to language barriers and foreign-born patients. It does not focus solely on health risks and benefits in ethnic groups. 22. During an orientation class, the medical units nursing educator is presenting education on transcultural nursing to a group of new nursing graduates. What should the staff educator identify as the underlying focus of transcultural nursing? A) The underlying focus of transcultural nursing is to enhance the cultural environment of institutions. B) The underlying focus of transcultural nursing is to promote the health of communities. C) The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care. D) The underlying focus of transcultural nursing is to promote the well-being of discrete, marginalized groups. Ans: C Feedback: The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care that promotes the well-being or health of individuals, families, groups, communities, and institutions. It is not limited to institutions, communities, or marginalized groups. 23. A hospitals written policies and procedures are being reviewed as part of an accreditation process. Which of the following policies are congruent with the principles of culturally competent nursing care? Mark all that apply. A) A policy that outlines the appropriate use of translation services B) A policy guiding staff in the care of patients with different values C) A policy that requires staff from different cultures on each unit Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 135 D) A policy that establishes flexible regulations pertaining to visitors E) A policy that gives priority to patients born outside the United States Ans: A, B, D Feedback: Policies that promote culturally competent care establish flexible regulations pertaining to visitors (number, frequency, and length of visits), provide translation services for nonEnglish-speaking patients, and train staff to provide care for patients with different cultural values. Cultural competence does not depend on culturally diverse staff on every unit and it does not necessarily prioritize the interests of individuals born outside the country. 24. Giger and Davidhizar (2012) created an assessment model to guide nurses in exploring cultural phenomena that might affect nursing care. When using this model in the care of a patient who has had a transurethral prostate resection (TUPR), what area of care would be influenced most directly? A) Transferring the patient from a stretcher to a bed B) Documenting the patients vital signs and level of consciousness C) Administering a scheduled dose of acetaminophen D) Explaining the rationale for continuous bladder irrigation (CBI) Ans: D Feedback: Giger and Davidhizar identified communication, space, time orientation, social organization, environmental control, and biologic variations as relevant phenomena. Explaining CBI requires clear communication. Transferring a patient to a bed, administering Tylenol, or documenting are nursing responsibilities that are less directly relevant to this model. 25. A 56-year-old woman who emigrated from Vietnam as an adult was admitted with a urinary tract infection, but has now developed urosepsis. The nurse is in the process of changing the patients plan of care accordingly. The nurse should consider what phenomenon that tends to occur in patients of all ages when they are ill? A) Tendency to regress in language skills B) Tendency to become more passive C) Tendency to become more involved in care Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 136 D) Tendency to regress in age-appropriate behavior Ans: A Feedback: During illness, patients of all ages tend to regress, and the regression often involves language skills. The other tendencies do not apply in this case. 26. A nurse is auditing the care of a recently discharged patient and is appraising the patients care in light of Leiningers theory of Culture Care Diversity and Universality. Specifically, the nurse is looking for evidence that caregivers implemented professional actions and decisions that helped the patient achieve a beneficial or satisfying health outcome. What aspect of Leiningers theory is the nurse addressing? A) Cross-care accommodation B) Culture care restructuring C) Cultural reordering D) Patient modification Ans: B Feedback: Culture care restructuring or repatterning refers to professional actions and decisions that help patients reorder, change, or modify their lifestyles toward new, different, or more beneficial health care patterns. The other listed options are not part of Leiningers theory. 27. A nurse is caring for a child with a diagnosis of hemophilia. The child is in need of a blood transfusion, which her familys religious beliefs forbid. What term would best describe this religions beliefs and their impact on health care for this child? A) Acculturation B) Cultural imposition C) Cultural taboo D) Cultural blindness Ans: C Feedback: Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 137 Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. The other answers do not apply. 28. A nurse has been having a number of challenging nursepatient interactions when providing care for a patient whose surgery was complicated by a medical error. When interacting with patients and families, of what must the nurse be cognizant? A) Her own level of health B) The culture of the institution C) The need to promote acculturation D) Her own cultural orientation Ans: D Feedback: Because the nursepatient interaction is the focal point of nursing, nurses should consider their own cultural orientation when conducting assessments of patients and their families and friends. The nurses health is relevant, but secondary. Similarly, the institutional culture is not a priority. Acculturation is not actively promoted by the nurse. 29. After working with a patient who has human immunodeficiency (HIV) for several weeks, the nurse has become more aware of the role of health disparities. Which of the following variables are known to underlie health disparities? Select all that apply. A) Poverty B) Isolated geographic location C) Overdependence on publicly funded facilities D) Male gender E) Allergy status Ans: A, B, C Feedback: Many reasons are cited for these disparities, including low socioeconomic status, health behaviors, limited access to health care because of poverty or disability, environmental factors, and direct and indirect manifestations of discrimination. Other causes include lack of health insurance; overdependence Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 138 on publicly funded facilities; and barriers to health care, such as insufficient transportation, geographic location (not enough providers in an area), cost of services, and the low numbers of minority health care providers. Male gender and a patients allergy status are not identified as contributors to health disparities. 30. The future of transcultural nursing care lies in finding ways to promote cultural competence in nursing students. How can this goal be best accomplished? A) By offering multicultural health studies in nursing curricula B) By enhancing the content of community nursing classes C) By requiring students to care primarily for patients from other ethnic groups D) By screening applicants according to their cultural competence Ans: A Feedback: Nursing programs are exploring creative ways to promote cultural competence and humanistic care in nursing students, including offering multicultural health studies in their curricula. Enhancing the content of community nursing classes would not necessarily achieve this goal. Matching students to patients from other cultures is often impractical and applicants are not screened by their cultural competence. 31. A nurse provides care in an inner-city hospital that serves a culturally diverse population. When attempting to foster positive and therapeutic nursepatient interactions, the nurse should recognize that these interactions are primarily dependent on what variable? A) The knowledge of patient tendencies during illness B) The nurses ability to work with a multicultural health care team C) The ability to understand and be understood D) Cultural diversity among the unit staff Ans: C Feedback: Nursepatient interactions, as well as communications among members of a multicultural health care team, are dependent on the ability to understand and be understood. Nursepatient interactions are not dependent on the knowledge of patient tendencies during illness, the nurses ability to work with a multicultural health care team, or cultural diversity among the staff on the unit. Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 139 32. A nurse who provides care on a busy medical unit is aware that his own beliefs do not always coincide with the beliefs of patients from some cultural backgrounds. What aspects of patient care may be most influenced by diverse cultural perspectives? A) Pharmacokinetics and pharmacodynamics B) Monitoring fluid balance C) Monitoring food intake D) Obtaining informed consent Ans: D Feedback: Many aspects of care may be influenced by the diverse cultural perspectives held by health care providers, patients, families, or significant others. One example is the issue of informed consent and full disclosure. The other aspects of care can also be influenced by cultural differences, but most often to a lesser degree. 33. Personal space and distance is culturally dependent and can impact nursepatient interactions significantly. What is the best way for the nurse to interact with a patient who has a different cultural perspective on space and distance? A) Allow the patient to adopt a position that is comfortable for him or her. B) Realize that sitting close to the patient is an indication of warmth and caring. C) Position yourself 10 to 12 feet from the patient to accommodate the most common cultural preferences. D) Remember not to intrude into the personal space of the elderly. Ans: A Feedback: If the patient appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the patient should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. Older adults do not share a common perspective on personal space. A distance of 10 to 12 feet is not normally necessary. Close proximity can be interpreting as being invasive by some individuals. 34. Touch, to a great degree, is culturally determined. When providing care for a patient who belongs to a Hispanic culture, which of the following may be considered inappropriate in a health care setting? Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 140 A) Grandmothers helping in the care of pediatric patients. B) Patients asking questions of health care providers. C) Health care information being given to a female member of the family. D) Males participating in health care activities. Ans: D Feedback: The meaning people associate with touching is culturally determined to a great degree. In some cultures (e.g., Hispanic, Arab), male health care providers may be prohibited from touching or examining certain parts of the female body. Similarly, it may be inappropriate for females to care for males. In the Hispanic culture, grandmothers often care for pediatric patients; the female of the family is often held responsible for the familys health care and health care information. Males of the Hispanic culture generally do not participate in health care activities when a member of their family is ill. There is no prohibition against asking questions. 35. A 54-year-old African American man has presented for a follow-up appointment shortly after being diagnosed with hypertension and being placed on an angiotensin-converting enzyme (ACE) inhibitor. The nurse takes the patients vital signs at the beginning of the appointment and obtains a blood pressure of 177/96 mm Hg. What factor should the nurse consider in light of the patients sustained high blood pressure? A) The patients culture may not prioritize taking a medication on a regular basis. B) Biologic variations may be influencing the effectiveness of the medication. C) The patients culture may not acknowledge symptom-free problems such as blood pressure. D) The patients diet may be negatively affecting the effectiveness of the medication. Ans: B Feedback: Biologic variations can be highly significant, particularly in the use of antihypertensives in African American patients. This is more likely than culturally mediated views on medication adherence, symptom-free diseases, or diet. 36. A nurse is planning the care of a 48-year-old woman who has just received a diagnosis of breast cancer. The patient has been explicit about her desire to integrate a variety of complementary therapies into her treatment regimen. What is the nurses primary responsibility around the use of complementary therapies? Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 141 A) To become skilled in administering as many complementary therapies as possible B) To liaise between practitioners of complementary therapies and the medical team C) To examine the evidence base underlying each of the patients chosen complementary therapies D) To assess the patients use of complementary therapies in order to promote safety Ans: D Feedback: Nurses must assess all patients for use of complementary therapies, be alert to the danger of herbdrug interactions or conflicting treatments, and be prepared to provide information to patients about treatments that may be harmful. However, nurses must be accepting of patients beliefs and right to autonomy (i.e., to control their own care). It is not the nurses role to be the intermediary between practitioners and the medical team or to evaluate the effectiveness of therapies. The nurse is also not responsible for becoming skilled in administering as many complementary therapies as possible. 37. Agency policies are important to achieve culturally competent care. When reviewing a hospitals current policy framework, which of the following actions has the potential to improve the overall level of culture competence? A) Reducing the institutions dependence on English for communication B) Promoting members of minority groups to higher profile positions C) Eliminating written information from staff members identification badges D) Creating greater flexibility in visiting hours Ans: D Feedback: Policies that promote culturally competent care establish flexible regulations pertaining to visitors, such as the number, frequency, and length of visits. Eliminating written information from staff members identification badges is unnecessary and of little benefit. Cultural competence does not require a reduction in the use of English. Promoting members of minority groups to higher profile positions on the sole basis of ethnicity would be unethical. 38. A nurse is describing and demonstrating the technique for emptying a Vietnamese patients surgical drain, knowing that the patient will soon be discharged home with the drain in place. As the nurse is explaining, the patient laughs at times that appear unrelated to what the nurse is saying or doing. How should the nurse best understand the patients behavior? Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 142 A) The patients sense of humor is culturally mediated and may be unfamiliar to the nurse. B) The patient may believe that she has sufficient knowledge and skill to empty the drain. C) The patient may be unable to fully comprehend the information the nurse is trying to convey. D) Individuals from the patients culture may not normally explain and demonstrate at the same time. Ans: C Feedback: Inappropriate laughter can signal a lack of understanding. This is more likely than the presence of a culture-specific sense of humor in this particular context. It is unlikely that there is a prohibition against simultaneous explaining and demonstrating. Laughing is unlikely to suggest that teaching and learning are unnecessary. 39. A nurse is providing care for a female patient who is Hispanic. The care team is discussing the patients nutritional status and one of the nurses colleagues states, I suppose we should try to get her some tacos or burritos since thats what shes probably used to. How should the nurse best interpret the colleagues statement? A) The colleague may have stereotypical views of Hispanics. B) The colleague is exemplifying the process of acculturation. C) The colleague is aware of the dietary characteristics of Hispanic culture. D) The colleague may harbor resentment against Hispanics. Ans: A Feedback: Presuming that Hispanics rely on tacos and burritos likely reflects a stereotype of this culture, but is less likely to be motivated by resentment. This statement does not demonstrate acculturation. The colleagues statement reflects a stereotype, not an accurate assessment of the patients diet and culture. 40. Computed tomography of a 72-year-old woman reveals lung cancer with metastasis to the liver. The patients son has been adamant that any bad news be withheld from his in order to protect her from stress, stating that this is a priority in his culture. How should the nurse and the other members of the care team best respond? A) Explain to the son the teams ethical obligation to inform the patient. B) Refer the family to social work. Downloaded by Norman Dominic Ebro ([email protected])  lOMoARcPSD|47175070 Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 143 C) Have a nurse or physician from the patients culture make contact with her and her son. D) Speak with the son to explore his rationale and attempt to reach a consensus. Ans: D Feedback: Nurses must promote open dialogue and work with patients, families, physicians, and other health care providers to reach the culturally appropriate solution for the individual patient. A referral to social work is not a sufficient response and enlisting a caregiver from the same culture may not be ethical or effective. Downloaded by Norman Dominic Ebro ([email protected])