Chapter 5

A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms:

require an individualized approach by the nurse.

A nurse caring for clients of different cultures in a hospital setting attempts to make eye contact with clients when performing the initial assessment. What assumption might the nurse make based on common cultural practices?

A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply.

A Native American patient An Alaska Native A White patient A Hispanic patient

Which client admitted to the emergency department might require the nurse to include interventions aimed at addressing culture shock in the plan of care?

A client who recently immigrated and fell from a ladder

A community health nurse is providing care to a group of Hispanic people living in an area that is predominantly populated by white people. What are the Hispanic people in this community an example of?

A minority

A Catholic priest baptizes a stillborn baby of a Catholic family. What type of practice is this considered?

A ritual

A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate?

Ask the client how the client wants to be treated based on the client's values and beliefs.

The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?

Ask the client if a spiritual leader is desired.

A nurse is providing care to a client who is from a different culture. Which aspect about culture would be most important for the nurse to integrate into the client's care?

Not all members of the same culture act and think alike.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply.

People may be members of multiple cultural groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices may evolve over time but mainly remain constant.

Which statement best conveys the relationship between race and ethnicity?

Race denotes physical characteristics, while ethnicity is rooted in a common heritage

Which aspects of nursing make it recognizable as a subculture? Select all that apply.

Rituals Manner of dress Language used

A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change?

The client states, "I feel like I abandoned my religion."

The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client?

The interpreter should understand the health care system.

Persistent gaps between the health status of minorities and non-minorities are defined as:

health disparities.

Ethnicity (race)

sense of identification with a collective cultural group, largely based on the group members' common heritage. One belongs to a specific ethnic group or groups either through birth or through adoption of characteristics of that group.

The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond?

"Can you describe what you are feeling when you try to move?"

The nurse is caring for a client who is admitted for hypertension (HTN). The nurse notes that the client has not been eating the food provided, and family members have brought in homemade food. What would be the best response by the nurse?

"Can you tell me what foods you prefer to eat and what your family is bringing you?"

The nurse has just attended a seminar on concepts of cultural diversity. Which statement made by the nurse would require further education?

"Culture cannot be influenced, and you are born with your culture."

The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the best response by the nurse?

"We can wait until your spiritual healer arrives and work together to answer these questions."

A nurse is admitting a client to the unit. Which cultural question is most appropriate?

"What are your dietary needs and preferences?"

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive?

"What types of food do you eat for meals?"

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention?

Ask an interpreter for help

A nurse is conducting an ethnographic interview with a client. Which step would the nurse do first?

Ask an open-ended, general question

When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response?

Ask the client about personal space preferences.

When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?

Assessment of eye contact, personal space, and social taboos

White common health problems

Breast cancer Heart disease Hypertension Diabetes mellitus Obesity

A nurse is working to develop cultural competence. Which activities would be appropriate for the nurse to engage in when exploring the nurse's own cultural awareness? Select all that apply.

Critical reflection Feedback from colleagues Self-assessment

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process?

Cultural assimilation

A client believes that the illness is caused by an imbalance of yin and yang. The nurse states, "You can call it whatever you believe, but you have a metabolic disorder." What is this nurse demonstrating?

Cultural blindness

A client is admitted with end-stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse whether an acupuncturist can come to the hospital to help manage the pain. The nurse states, "You won't need acupuncture. We have pain medications." Which characteristic has the nurse displayed?

Cultural imposition

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias?

Cultural imposition

Which term describes the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture?

Cultural imposition

A family recently immigrated to a new country. The parent reports that the teenager is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse?

Culture shock

A nurse is caring for a 79-year-old client who is new to a long-term care facility. Previously, the client lived in a rural community in a household consisting of the client and an adult child. The child is no longer able to care for the client. The client appears disoriented and reports being bothered by the "bright lights and constant activity." The nurse appropriately documents what condition in the chart?

Culture shock

culture shock

Culture shock may result in psychological discomfort or disturbances, because the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new culture. The person may then feel foolish, fearful, incompetent, inadequate, or humiliated. These feelings can eventually lead to frustration, anxiety, and loss of self-esteem.

Eastern European health problems

Cystic fibrosis Gaucher's disease Spinal muscular atrophy Tay-Sachs' disease

cultural competence

Developing an awareness of one's own existence, sensations, thoughts, and environment to prevent them from having an undue influence on those from other backgrounds Demonstrating knowledge and understanding of the patient's culture, health-related needs, and culturally specific meanings of health and illness Accepting and respecting cultural differences in a manner that facilitates the patient's and family's abilities to make decisions to meet their needs and beliefs Not assuming that the health care provider's beliefs and values are the same as the patient's Resisting judgmental attitudes such as "different is not as good" Being open to and comfortable with cultural encounters Accepting responsibility for one's own education in cultural competence by attending conferences, reading professional literature, and observing cultural practices

Hispanic common health problems

Diabetes mellitus Lactose intolerance

Native Americans and native Alaska natives common health problems

Heart disease Cirrhosis of the liver Diabetes mellitus Fetal alcohol syndrome

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness?

How does having COPD affect your lifestyle?

Asian common health problems

Hypertension Cancer of the liver Lactose intolerance Thalassemia

African Americans common health problems

Hypertension Stroke Sickle cell anemia Lactose intolerance Keloids

A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority?

Language assessment

The nurse is caring for a client who perceives time differently. What action should the nurse take for this client?

Maintain flexibility when the client requests interventions at specific times.

A nurse overhears another nurse make a statement that indicates racism. The nurse makes this determination based on which characteristic indicative of social value?

Skin color

A nurse is working with an interpreter to communicate with a client who speaks very little of the nurse's language. Which actions would be appropriate for the nurse to take? Select all that apply.

Speak to the client rather than the interpreter. Use simple sentences to convey the verbal message. Rephrase a question using different words if the answer is inappropriate.

A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation?

Stereotyping

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating?

Stereotyping

A family has immigrated and settled in a neighborhood that primarily speaks their native language. The nurse caring for this family recognizes that which family member will likely require the greatest amount of time to learn the dominant language?

The 45-year-old mother in the family who does not work outside the home

A new client comes to the primary care clinic and asks for help treating head lice. The nurse assesses that the client lives in low-income housing, and nine other people live with the client in a one-bedroom apartment. Which consideration is the priority nursing concern?

The client does not have running water.

Which is a cultural norm of the health care system?

There is the use of a systematic approach and problem-solving methodology.

A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care?

Treating each patient at the clinic as an individual

When caring for a patient from a cultural or ethnic group different from your own, it is important to perform a transcultural assessment of communication

What language does the patient speak during usual activities of daily living? How well does the patient speak and write in English? Does the patient need an interpreter? Are family members or friends available? Are there people the patient would not want to serve as an interpreter? How does the patient prefer to be addressed? What cultural values and beliefs of the patient (such as eye contact, personal space, or social taboos) may change your techniques of communication and care? How does the patient's nonverbal behavior affect the responses of members of the health care team? What are the cultural characteristics of the patient's communications with others?

cultural assimilation

When a minority group lives within a dominant group, many members may lose the cultural characteristics that once made them different, and they may take on the values of the dominant culture.

cultural diversity

can be defined as the coexistence of different ethnic, biological sex, racial, and socioeconomic groups within one social unit

Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for:

client's height.

A parent informs the nurse that immunizations are against the parent's cultural and religious beliefs and the parent does not want the child to receive immunizations. The nurse proceeds to inform the parent that the child will be consistently ill and will not be allowed to start school unless immunized. The nurse also informs the parent that the nurse had all of the nurse's own children vaccinated. The nurse's behavior an example of:

cultural imposition.

culture

defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living

The use of one's culture as a cultural standard is known as:

ethnocentrism.

Subculture

large group of people who are members of the larger cultural group but who have certain ethnic, occupational, or physical characteristics that are not common to the larger culture

Ethnocentrism

the belief that the ideas, beliefs, and practices of one's own culture are superior to those of another's culture.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply.

A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence.

A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert?

Client