ch 10

A nurse was very excited at being given the opportunity to spend a year working in Botswana. After 2 months, however, the nurse was feeling both depressed and angry. Knowing the agreement was to stay a calendar year made the nurse feel panic-stricken. Which of the following problems is the nurse most likely experiencing? a. Culture shock from being in a culture very different from that at home b. Fatigue from having to constantly ask a translator to explain what clients are saying c. Frustration because high-technology equipment is not available in this developing country d. Tiredness from learning all the differences in nursing techniques in this clinical setting

A Anger, depression, panic, denial, and depression may all result from culture shock. Culture shock can have serious consequences. It can lead to acts of aggression toward self or others, a loss of appetite and sleep, and general malaise that can result in death. Fatigue, frustration, and tiredness are all possible explanations; however, the most likely problem is culture shock.

The community/public health nurse was conducting a blood pressure clinic. The nurse noted that a Chinese client's blood pressure was 80/50. The client stated that he was taking propranolol for hypertension. Which of the following would be the most probable reason for this low blood pressure? a. The client may be more sensitive to the effects of beta-blockers. b. The client may never really have had hypertension. c. The client may have taken too much of the medication each day. d. The client may not have told the physician all the other medications he was taking.

A Some Chinese people are considerably more sensitive than are white people to the effects of beta-blockers on heart rate and blood pressure. Biologic differences can be a factor because drugs are standardized primarily on data from white men.

A nurse saw a man from an Arab country asking a physician how his wife was doing. As the physician responded to the question, the physician backed away. The man again moved up close to the physician to ask another question, which the physician answered while again backing up. Which of the following conclusions can be drawn by the nurse? a. Both were trying to arrange the space between them to be comfortable. b. The man had poor personal hygiene, so the physician was distancing himself from the client. c. The physician did not want to stand that close to an Arab. d. These things happen; there is no particular meaning to this event.

A Space is a physical boundary. As the gentleman from the Arab country tried to set up the appropriate amount of space for a fairly intimate conversation, the American backed up to add the social space expected for a professional conversation.

A nurse has been assigned to care for a bisexual client. Which of the following would be important for the nurse to recognize about this client? a. The client may have experienced disparities in health status and care. b. The client has received care similar to that of all other U.S. citizens. c. The client may be resistant to education by the nurse. d. The client has resisted mainstream lifestyles and behaviors.

A This client is a member of the lesbian, gay, bisexual, transgendered, or intersex (physically ambiguous gender) (LGBTI) group. LGBTI individuals may have suffered significant disparities in health status and health care in relation to their sexual identity and behavior and unique needs. Thus, their health care has not been similar to that of other U.S. citizens. There is no evidence that they would not be receptive to education from the nurse. Moreover, although the client has resisted mainstream lifestyles and behaviors, this would not be as important to consider in providing care.

A middle-aged woman had decided against getting treatment for her just-diagnosed uterine cancer, explaining to the nurse that the family needed to keep its resources for her daughter's new baby. Which of the following is the most likely explanation for the nurse's frustration with the client? (Select all that apply.) a. A belief that the individual must protect personal life and health b. Inability to accept that some cultures put group needs before individual needs c. Lack of understanding the importance of childbirth in some cultures d. Feeling strongly that disease must be fought, not accepted e. Seeing time as linear, with every second irreplaceable and passing quickly f. Being unsuccessful at getting the client to understand that the cancer could kill her

A, B, D, E Most cultures have strong values about childbirth, so that should not be the problem. Many Americans see time as linear, rapidly passing, and as something to be used efficiently, whereas other people see time as circular and never ending. To someone who is a professional and acculturated to dominant American values, wasting time before beginning treatment would be nonsensical. Disease must be fought, and clients are supposed to cooperate with health care professionals' suggestions. Other cultures may be group oriented rather than individual oriented and accept disease.

What does the National Center for Cultural Competence suggest to assist nurses in giving culturally competent care? (Select all that apply.) a. Adapting to the diversity found in the community where the nurse is employed b. Becoming aware of personal cultural values, beliefs, and practices c. Explaining to each newly admitted client how the American health care system is organized and his or her role in it d. Learning the effect of sexual orientation and gender on families and communities e. Refusing to work with any ethnic group other than a nurse's own f. Using assessment tools to increase understanding of the client's perspective

A, B, F The National Center for Cultural Competence stresses that cultural competence is a process in which nurses strive to work effectively within a community with persons from diverse cultural backgrounds. A nurse begins with a cultural self-assessment to become aware of personal values, attitudes, beliefs, and practices to help overcome ethnocentric tendencies and cultural stereotypes. The nurse must take action to become comfortable and familiar with cultural groups in the area where the nurse is employed.

A nurse, who is of German descent, was told to watch a newly admitted African American client for any signs of cyanosis or pallor. Which of the following actions should be taken by the nurse? (Select all that apply.) a. Applying pressure to the nail bed and observing how quickly color returns b. Asking the visiting family members to tell the nurse if they notice such signs c. Checking the palms of the hands and the soles of the feet d. Consistently checking the blood pressure and pulse rate every 15 minutes e. Looking between the strands of hair on the head for evidence f. Telling the nurse in charge of the floor to have someone else, preferably an African American nurse, care for the client

A, C Although none of these actions is totally inappropriate, the most effective would be to apply pressure to the nail bed and observe the rapidity of color return and to check the surfaces with the least amount of pigmentation (forearms, soles of feet, palms of the hand, abdomen, and buttocks).

A male nurse was admitting a woman from Italy who spoke perfect English. The nurse had no idea what would be considered appropriate behavior for a male nurse with a female client from outside the United States. Which of the following statements should be made by the nurse? a. "Can you tell me about Italy? I've always wanted to go there." b. "I don't know much about care in your country. Could you tell me what you expect from a nurse in a hospital?" c. "I understand you have national health care in your country, but you do understand that here you will have to pay for all your care?" d. "You'll probably prefer a female nurse. I'll have a female colleague come in shortly."

B Asking the client about her expectations will give the male nurse a chance to explain health care in the United States and how he may be able to help her. Also, if there are issues related to gender and having a care provider of a different gender, his opening will give her an opportunity to express any reservations.

Which of the following statistics related to diversity in the United States is accurate? a. One per five people belongs to an ethnic or racial minority. b. One per three people identifies with an ethnic or racial minority. c. The percentage of people identifying with a minority group is decreasing. d. The percentage of people identifying with a minority culture has become the majority.

B More than 110 million, or one per three, people self-identify with one or more of the federally recognized racial and ethnic minority groups. Professionals are expected to respect all people. There continues to be growth among racial and ethnic minority populations. Currently, the majority of the population is composed of non-Hispanic white people (63.7%).

A nurse went to a convention in a large city with which the nurse was unfamiliar. The nurse was somewhat anxious about finding the convention center, but once there, the nurse relaxed and eagerly entered into interaction with other attendees. Which of the following would have been the most likely reason the nurse became comfortable? a. Enjoyment in learning more about topics that were relevant to current practice b. Understanding the perspective of most nurses c. Eagerness about hearing the keynote speaker d. Being an extrovert who loved interacting with people

B The nurse was comfortable with other nurses because they share a non-ethnic culture based on occupation or profession with shared experiences and perspectives

A nurse was proud of having completed a professional education program on cultural care of Hispanics. It was surprising when the Hispanic client for whom the nurse had been caring did not seem to act very "Hispanic." Which of the following considerations is the nurse not taking? a. The client may have been trying to demonstrate behaviors to please the nurse. b. The client may have customs that are not identical with the Hispanic culture. c. The client may be in too much pain to demonstrate cultural behaviors d. The client may not have been truthful when claiming to be Hispanic.

B The nurse, who had just learned about the Hispanic culture, may have been assuming that a given custom is shared by all members of a culture, which is not true.

Of the following statements about anorexia nervosa, which are accurate? (Select all that apply.) a. It is an eating disorder that results in extreme obesity. b. It is considered a culture-bound syndrome. c. It is an epidemic among American teenagers. d. It is often discovered only when friends see the person vomiting meals. e. It is seen in socioeconomic classes that emphasize thinness. f. It is seen in very low income, lower socioeconomic class women.

B, E Anorexia nervosa is considered a culture-bound syndrome because it is found only in certain population groups, specifically Western cultures with sociocultural emphasis on body type and excessive preoccupation with thinness. The disease represents self-imposed starvation

Which of the following criteria would be useful for a nurse in choosing a good informant who can explain what is and what is not appropriate behavior in a group? a. Being in a position of power and authority and having an appropriate title b. Being careful to describe reality as the nurse wants to hear it c. Being a member of the culture who has been actively involved for a long time d. Being willing to explain as long as his or her knowledge is financially recognized

C A good informant is thoroughly acculturated and currently involved, describes reality in local terms rather than the way the informant thinks the nurse wants to hear it, and is willing to share his or her time and knowledge.

Which of the following is the most significant barrier to Americans seeking appropriate health care? a. Culture b. Ethnicity c. Lack of insurance d. Race

C Although all the options can be barriers to seeking and obtaining appropriate health care, lack of insurance or other means to pay for health care is the most crucial barrier.

A nurse stressed to an oncology patient the importance of returning to the outpatient clinic promptly at 8 AM for the next treatment, but the client arrived at 3 PM. Which of the following would be the most likely explanation for the client's tardiness? a. The client needed the appointment written down so the client could remember the exact time. b. The client's employment had to come first, so the clinic visit was second in priority. c. The client's perception of time was not linear or future oriented. d. The client was having too much discomfort from the treatment to have another treatment so soon.

C Although all the options could be true, the least obvious but perhaps most important was that the client's perception of time may have differed from that of the nurse. Nurses focus on linear time, watches, and being accurate and punctual. Some persons see time as circular and never ending and as a gift to be enjoyed, so they may not be concerned with punctuality.

The nurse was determined to become more culturally competent with at least one cultural group besides the nurse's own. Which of the following actions would be most useful for professional practice? a. Buying groceries from a small ethnic grocery store in the neighborhood b. Buying only items made outside the United States c. Learning conversational Spanish d. Moving into an apartment house owned by a member of another ethnic group

C Although all these actions might well be excellent learning experiences, learning Spanish would be most useful because Spanish is the second most commonly spoken language in the United States. By learning a language, a person also learns a great deal about the values of that culture.

A nurse was so angry at a family for not being home when the nurse arrived for their appointment that the nurse wanted to drop the family from the agency caseload. What would the agency supervisor need to point out to the nurse? a. Clients can have emergencies that interfere with plans. b. Communication about the time of the appointment may not have been clear. c. Nurses expect promptness and compliance, but not all clients feel the same way. d. Perhaps the nurse made an error in writing down the appointment date and time.

C Although any of the reasons may have been true in this situation, the fact that the nurse was so angry suggested that a cherished value had not been upheld. The nursing profession culture includes values of promptness, neatness, and organization. Tardiness, disobedience, and disorganization are antithetical to nursing values. The issue may have been a culture clash.

A nurse was teaching a client how to plan his diabetic diet. The client explained that he was on the road a lot and ate in truck stops where they did not serve that kind of food. Furthermore, both his mother and father had died of diabetic complications, and he knew he would probably have the same fate. Which of the following would be the most appropriate action for the nurse? a. Explaining why the client might have to change careers and be more optimistic b. Recognizing that the client has a present time orientation and stop wasting effort on teaching him about a diet he will not follow c. Reviewing the client's priorities and see what compromises in nutrition might be possible in his job d. Trying to help the client see the importance of planning for the future

C Although the client seems focused on present time orientation and is rather fatalistic, immediately giving up is not a viable option. The client's occupation and lifestyle probably cannot be changed immediately; therefore, only compromises are realistic. The nurse and the client will have to discuss what changes can be made in his eating habits.

Which of the following is the best definition of culture? a. An appropriate way to behave within a group b. A choice of lifestyle behaviors by a group c. Learned and shared beliefs, values, and lifeways of a group d. Unconscious behaviors of a group

C Culture consists of the learned and shared beliefs, values, and lifeways of a group that are generally transmitted from one generation to the next and influence people's thoughts and actions.

What is the primary reason why there are differences in health outcomes among the various ethnic groups? a. There is decreased access to health care and few care providers from their ethnic group. b. Members of ethnic groups rarely have life insurance, so they cannot afford to obtain care. c. Professionals engage in discrimination, stereotyping, and uncertainty. d. Minorities are less educated, so they do not take care of themselves appropriately.

C Disparities exist because of the operation of the health care system and discrimination, biases, stereotyping, and uncertainty of the clinicians.

A man was badly hurt in a car accident caused by a drunk driver and was having a large amount of pain. The man cried, "What did I do to deserve this? I wasn't the one drinking." Which of the following would be the most appropriate response by the nurse? a. "There is always a reason behind any accident and injury." b. "The pain will start to improve. You just need to give it some time." c. "I'm sorry you have so much pain. How have you been dealing with it?" d. "Can I get you more pain medication?"

C Each response reflects a particular perspective on pain and suffering. Because the nurse has no data as to the client's perspective, the nurse must ask questions related to the pain until the nurse has a clearer understanding of the client's beliefs. This action would be the priority and then the next step would be to administer pain medication if necessary.

Why will the concept of ethnicity decrease in value to health professionals in the future? a. Assessment and treatment will become more accurate according to a person's race. b. Ethnicity as a concept mainly helps clients have a sense of belonging and loyalty. c. Persons from different ethnic groups are intermarrying, and their children are multiracial. d. The concept of ethnicity is less informative than the term race.

C Ethnicity is used as a way of self-identification and gives a sense of belonging. However, its usefulness to health professionals will decrease as groups intermarry and their children become multiracial.

Which of the following groups is the largest ethnic minority in the United States? a. African Americans b. Asian immigrants c. Hispanics d. American Indians/Alaskan natives

C Hispanics constitute the largest ethnic minority group, accounting for more than 16% of the total U.S. population. Black people constitute the largest racial minority group, accounting for 12.6% of the total population. Asians constitute 4.8% of the total population, and American Indians/Alaska Natives constitute 0.9%. All minority populations have grown.

Why would a nurse attend a professional development program about personal beliefs, values, and ethnic heritage? a. It will be worth sharing with other staff at the agency. b. It will decrease the nurse's racism. c. It will help the nurse recognize her own ethnic perspective. d. It will help the nurse work better with others.

C Such professional education programs help attendees recognize their own beliefs and values and realize that other people might have differing values.

A nurse was assigned to care for a client who was speaking with his young daughter in an Asian language. Because the nurse spoke only English, which of the following actions should be taken by the nurse? a. Ask the young daughter whether she knew English and could translate. b. Ask the young daughter whether the client's wife was available to translate. c. Call the nursing office to see whether any nurse in the hospital spoke the client's language. d. Check the hospital resource manual for the telephone number of a translator who spoke an Asian language.

C The best choice, if available, would be a nurse who was bilingual. If not, an interpreter, preferably of the same gender, would be sought among the staff or by phone. Although the young daughter or the wife might know English, because of age and gender differences, having either translate would not be appropriate.

A nurse is completing a cultural assessment. Which of the following actions would the nurse take first? a. Assessing the client's religious beliefs b. Asking the client with which culture he or she identifies c. Establishing rapport and a trusting relationship with the client d. Evaluating appropriate data collection tools

C The first step of a cultural assessment is to establish a rapport or trust before collecting any data. The data collection tools would have been evaluated before a cultural assessment is completed with a client. Asking the client questions is part of the assessment process.

Which of the following is the best definition of a family for a nurse to use when planning nursing care? a. Related legally or by blood b. Considered "family" by the legal system c. Living in the same household d. Any person the client reports as being family

D Although all definitions are correct, the nurse will find it most helpful to include any person the client wants included.

Which of the following is the best way for a nurse to determine a client's ethnicity? a. Analyzing the client's actions and communication patterns b. Closely observing behaviors and customs c. Discussing with anthropologists how to recognize the various ethnic groups d. Querying "How do you identify yourself?"

D Although it certainly would be useful to observe and analyze a client's beliefs, actions, behaviors, and communication patterns, the easiest and most efficient way to determine ethnicity is simply to ask the client.

What is the relationship between race and ethnicity? a. Race is biologic, whereas ethnicity is psychologic. b. Race is skin color, whereas ethnicity is shared beliefs. c. Both race and ethnicity mean "visible subgroup." d. Race means "common physiology," and ethnicity means "common culture."

D Although sometimes used interchangeably, the terms have different meanings. Race refers to biologic features, whereas ethnicity refers to a shared culture.

The difference between an immigrant and a refugee is that the immigrant a. Has legal permission to receive government benefits, whereas the refugee does not. b. Is a legal member of society, whereas refugees have come into the country illegally. c. Is a member of a group that America wishes to welcome, whereas a refugee is not. d. Wants permanent residence, whereas refugees wish to escape persecution.

D An immigrant is seeking permanent residence with documentation and permission, whereas refugees are migrating to escape persecution that is based on race, religion, political persuasion, or nationality. Both may be legal residents, although achieving that status is more difficult for refugees.

The administrative team at a home care agency is discussing how they meet the Culturally and Linguistically Appropriate Services (CLAS) standards. Which of the following actions demonstrates the incorporation of these standards in practice? a. Requiring a small fee so that all patients will have a translator immediately available b. Using hand motions, pantomime, and touch to convey information c. Requiring all staff nurses employed in the hospital to be bilingual d. Using a computer to print index cards with essential phrases both in English and in the patient's language

D The CLAS standards suggest free language assistance, whereby bilingual staff and interpreter services are preferred. Although hand motions and pantomime may be used on a temporary basis, they are very prone to misinterpretation, and interpreters or a bilingual staff member must be sought immediately. The hospital cannot require any nurse to be bilingual, although such nurses should be actively recruited. Use of index cards is suggested in the text. In some geographic areas, so many ethnic groups use a particular hospital that having a computer program that could print the information needed in this instance would be a cost-effective way of being prepared.

Which of the following is a reason why each person is asked to report his or her race during the U.S. census? a. Race is a biologic reality defining persons with common biologic features. b. Race is a crucial variable, which explains the differences among different groups of people. c. Race is a historical tradition that must be upheld. d. Race is a way in which people identify themselves.

D The census has historically included this question, on the basis of the traditional concept of those who share common biologic features; however, there is no genetic difference among people, and many people have argued that the concept of race should not be used. At this point, race is primarily a concept reflecting how people identify themselves.