MH Chapter 5 : Cultural Implications

The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question? a. "What do you think is making you ill?" b. "When did you first feel ill?" c. "How can I help you get better?" d. "Did you do something to cause the illness?"

a. "What do you think is making you ill?" Rationale Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. While appropriate assessment questions, none of the remaining options are as well suited to gather culturally influenced information.REF: 86-87

Which statement best explains the term "worldview"? a. Beliefs and values held by people of a given culture about what is good, right, and normal. b. Ideas derived from the major health care system of the culture about what causes illness. c. Cultural norms about how, when, and to whom illness symptoms may be displayed. d. Valuing one's beliefs and customs over those of another group.

a. Beliefs and values held by people of a given culture about what is good, right, and normal. Rationale A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives. None of the other statements accurately describe the term worldview.REF: 78

In the Chinese tradition, disease is believed to be caused by what factor? a. Fluctuations in opposing forces b. Outside influences c. Members' disobedience d. Adoption of Western beliefs

a. Fluctuations in opposing forces Rationale In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces. None of the other options are included in the Chinese view of disease.REF: 80

According to the Western scientific view of health, what causes illness? a. Pathogens b. Energy blockage c. Spirit invasion d. Soul loss

a. Pathogens Rationale Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured. None of the other concepts are considered as illness produced by the Western view of health.REF: 79-80

Which idea held by the nurse would best promote the provision of culturally competent care? a. Western biomedicine is one of several established healing systems. b. Some individuals will profit from use of both Western and folk healing practices. c. Use of cultural translators will provide valuable information into health-seeking behaviors. d. Need for spiritual healing is a concept that crosses cultural boundaries.

a. Western biomedicine is one of several established healing systems. Rationale A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.REF: 85-86

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? a. "Is there someone in your community who usually cures your illness?" b. "What usually helps people who have the same type of illness you have?" c. "What questions would you like to ask about your condition?" d. "What sorts of stress are you presently experiencing?"

b. "What usually helps people who have the same type of illness you have?" Rationale Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client. No other option focuses on this information.REF: 87

A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization? a. Impaired sleep patterns b. Denial of anxiety or depression c. Unexplained physical pain d. Recent immigration to the United States

b. Denial of anxiety or depression Rationale Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. The client's behavior associated with the denial of any mental illness or understanding of the possible connection between the symptom/signs and a mental illness presents a need to explore the possibility of somatization. None of the other options support this possibility as directly.DIF: Cognitive Level: Apply (Application)REF: page 10TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure? a. The inability to achieve her personal goals in the workplace b. Shaming the family by being responsible for the error c. Feeling personally inadequate regarding dependability d. Traditional belief that failure may result in a changed fate

b. Shaming the family by being responsible for the error Rationale Eastern tradition, such as in China, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options A and C demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? a. "So, ethnicity refers to having the same life goals whereas culture refers to race." b. "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." c. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." d. "So, ethnicity refers to race, and culture refers to having the same worldview."

c. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." Rationale Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of either ethnicity and/or culture.DIF: Cognitive Level: Analyze (Analysis)REF: page 3TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? a. "Where can I find information on the concept of Yin-Yang?" b. "How do I go about arranging for a Chinese translator?" c. "What can I do to provide ethnic foods that are still low in fat?" d. "How can I explain why we can't provide for his request for acupuncture?"

c. "What can I do to provide ethnic foods that are still low in fat?" Rationale Cultural desire is a genuine interest in the patient's unique perspective; it enables nurses to provide considerate, flexible, and respectful care to patients of all cultures. Attempting to incorporate ethnic foods into the client's prescribed diet demonstrates all these characteristics. None of the other options are focused on providing such care.REF: 87-88

Which nursing behavior best demonstrates the concept of cultural competence? a. Acquiring knowledge about different cultures b. Educating patients about the cultural norms of the United States c. Adjusting personal practice to meet the patients' cultural preferences, beliefs, and practices d. Engaging in continuing education classes on culture in the process of becoming culturally competent

c. Adjusting personal practice to meet the patients' cultural preferences, beliefs, and practices Rationale Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.DIF: Cognitive Level: Apply (Application)REF: page 15TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

What tem is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices? a. Acculturation. b. Ethnocentrism. c. Enculturation. d. Cultural encounters.

c. Enculturation. Rationale Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.REF: 87-88

A nurse states, "I am so frustrated trying to communicate with clients when they insist on speaking in their language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which response by a peer best promotes culturally competent care? Select all that apply. a. "You are right, but all patients do have a right to an interpreter, so you need to comply." b. "I agree that it is frustrating. We should work with their family members to help convince them to speak English." c. "They will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage them to try speaking English." d. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." e. "When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known."

d. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." e. "When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known." Rationale Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English, an interpreter should be obtained for the patient.

Considering mental health, what term is used to define a deviation from expectations by members of the cultural group?? a. Hostility b. Lack of self-will c. Variation from tradition d. Illness

d. Illness Rationale Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness." None of the other terms are used to describe this concept.REF: 90

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects which cultural concept? a. Supernatural causes b. Negative forces c. Inheritance d. Yin-Yang

d. Yin-Yang Rationale Many Eastern cultures explain illness as a function of imbalance such as Yin-Yang. None of the other options are widely reflected in the Chinese culture.REF: 80