Cultural-end of chapter Q's. Ch1-13

What group of women are least likely to perceive themselves as overweight?

African American women

Which groups are not required to fast during Ramadan, a major Muslim religious observance

Anyone who is sick

what question may help identify social factors that would impact a patient's adherence?

Aside from your health, what else in your life is worrying you

Asian Indian patients who use alternative medical treatments are most likely to subscribe to which flavor of alternative medicine

Ayurvedic medicine

How should the physician respond when encountering patients with misconceptions regarding insulin therapy

Clarify the role of insulin by highlighting cause and effect

what are holistic healers called in Hispanic/latino culture?

Curanderos

Many latino patients incorrectly associate diabetes with which symptom

Depression

what factors might lead the parents of a Muslim or Arab adolescent patient to initially delay or refuse chemotherapy

Desire to consult with extended family members and or Imam first

What is true about the nature of acculturation

Differing patterns within families may lead to intergenerational conflict

It is never appropriate to use pejorative phrases when describing patients.

Don't use pejorative phrases when describing patients.

What is the importance of addressing a patient's anger during an office visit?

Enhances the physician's alliance with the patient

What approach should physicians use in taking care of uncooperative, self-abusing, or disruptive patients from a low socioeconomic group?

Ensure that personal biases do not taint clinical judgement

ETHNIC acronym

Explanation Treatment they have tried Healers or alternative medicines Negotiate treatment Interventions they can take Collaboration with patient, family, or healers

among Latino patients with diabetes, what factor is the most important in determining adherence to medication and instilling self-confidence

Family support

which criteria can often determine rates of illiteracy

If you think there is criteria that can determine if your patient is illiterate, you have not reached cultural competency

From which ethnic background are patients most likely to change their diet after being diagnosed with a health problem

Latino/hispanic

LEARN acronym

Listen with sympathy and understanding Explain your medical perceptions of problem Acknowledge and discuss diff and similarities Recommend treatment Negotiate agreement

the prevalence of sleep apnea, and its association with obesity, is greater among which groups

Native Americans and Hispanics

What service would be especially helpful for terminally ill Muslim patients

Negotiating a plan for outside visitors, especially the Imam

When communicating with Muslim patient about end of life issues what statement best shows respect and mindfulness about Muslim beliefs?

No one knows when, where or how someone will die

When is it appropriate to ask a Muslim patient about their sexual activity?

Only in a sensitive manner when it is relevant to the care of the patient

How should physicians respond to working professionals in comparison to unemployed or low-income patients

Physicians should promote patients' health regardless of their socioeconomic status

when meeting an androgynous(male)-appearing patient for the first time, what is the best approach

Refer to patient by full name, rather than using an engendered prefix. Ms. or Mr.

When preparing to examine a Muslim woman or girl it is appropriate to request that she...

Remove her clothes, keeping on the hijab if she prefers, and put on a gown and drape

In Arab culture and Islam, the following parties may participate in medically related decisions for an adolescent patient.

Senior family members, father, and individual parent

Four domains of social context "review of systems"

Social stressors and support network recent change of environment-have they moved Life control- do they have perceived control literacy- their level of literacy

How should physicians and office staff respond to patients who chronically miss appointments?

Speak directly to the patient about the missed appointments.

What approach is most effective in helping patients' with type two diabetes to lose weight

Suggest substituting healthy ingredients for meals and snacks based on the patient's cultural heritage and personal preferences

How can physicians effectively take care of patients from divers backgrounds

They should emphasize good communication in combination with understanding a patient's cultural context

How should a health care professional approach a colleague about their culturally insensitive behavior or remarks?

They should speak honestly, but respectfully, to the colleague.

Moxibustion or moxa, through heat generated by the burning of mugwort (spongy herb) is used by traditional Chinese practitioners to treat many conditions. what Western treatment is most likely to be impacted by concurrent moxibustion?

Topical medications

a complete discussion of contraception should include...

Verbal explanation of pros/cons for each method verbal and written descriptions of methods an opportunity for questions about how each method works

when a patient expresses anger about a physician's colleague, what is an appropriate response?

What concerns do you have about how you were treated?

What question can initiate the process of "LEARNing"

What do you think your sickness does to you?

who should be considered at risk for HIV

all patients should be considered at risk for HIV

when questioning a male about sexual orientation, what question is most appropriate

are you sexually active with other men

what may be the most effective approach to ensure good communication with a large family of hospitalized patient

ask family to choose an individual to be the point of contact with the health care team

How should health professionals respond to the widened definitions of prediabetes and diabetes by the World Health Organization, and other organizations

assist patients in identifying evidence based health care resources

what is an effective way to address cultural issues about personal contact in a clinical setting

attempt to accommodate patient's requests whenever possible, while providing medically appropriate care

What is the best approach when referring a Mexican patient with type two diabetes to a dietitian for nutrition therapy

attempt to identify a bilingual dietitian familiar with the Mexican diet

what are the three components that determine sexual orientation

attraction, cognition and behavior

what groups makes up the majority of users of complementary and alternative medicine in the US?

caucasians

what mode of decision making is prevalent among families of Asian Indian origin

communal deliberation

Cultural and religious issues may impact which of the following issues related to end of life care

creating and advanced directive using a feeding tube using medication for pain control

how might the perspectives of financially secure patients with respect to end-of-life care differ from those of disadvantaged patients

disadvantaged patients may interpret end-of-life care as an attempt to deny essential treatments

if patient understands the nature of sleep apnea and knows how to operate CPAP machine what measure would be effective in improving low CPAP adherence

discuss barriers that the patient has encountered when using the device

how could you provide culturally sensitive care to both partners in an arranged marriage

discuss perceived family pressures with each person individually and then together

how should physicians treat patients who they suspect are incapable of keeping follow-up appointments

discuss the importance of personal responsibility before administering follow-up care

when diet is affected by cultural factor, which in turn significantly impact a patient's health care, what approach is appropriate

discuss the underlying cultural factors related to the usual diet and explore options within that paradigm that might be better suited to their health

what question is associated directly with domain of "life control" in social context review of systems

do you ever feel that you are treated unfairly by the healthcare system

how should you respond to another provider's complaints about a patient that might reflect ethnic insensitivity

emphasize the primary importance of compassion toward patients

Direct observed treatment ( someone watching to ensure treatment is followed) is appropriate for people with multidrug resistant tuberculosis what is the best approach for physicians to initially take when a patient requires DOT

ensure the patient understands the diagnosis, importance of treatment and how this will impact their life

when domestic violence is suspected in a relationship, you should take which approach to address the issue.

explore the patient's inner thoughts and feelings, or their partner's behavior that might indicate ongoing abuse

what possible influence may family and friends' have on a patient's medication choices

family and friends may offer medical advice that contradicts the healthcare provider's advice

what approach may aid a provider in understanding the factors that affect patient adherence

find out the significant sources of stress in patient's life

what is true about marriage in China

free-choice marriage is a right for women age 20+, but some still practice arranged marriages

what is most likely to improve a patient's adherence to taking medications

having continuity of health care providers during office visits

what approach may lead to increased levels of patient's understanding

having them restate in their words the directions that have been given

what barriers to health care may have created disparities for lesbians in the US

homophobia

when patient requires long term care, what issues must be addressed by the family and the health care providers

how the patient and family feel about nursing homes

If you believe there is a language barrier with patient over the phone, what is best course of action

if available, ask a bilingual staff member to join the conversation

what is an important benefit of exploring a patient's explanatory model of illness

improved patient adherence and increased understanding of patient's perspective

What physician barrier can affect a patient's adherence?

inadequate explanation of instructions

what is an indicator of low literacy level in patients

incomplete health questionnaires

what is low health literacy associated with

increased hospitalizations

Poor adherence results in what outcomes?

increased patient morbidities and mortalities

how should provider respond when requested to withhold info about a diagnosis from family members

initiate further discussion with patient and help patient identify a surrogate decision maker

what question is taken from the "Treatment" portion of the ETHNIC acronym

is there anything you eat, drink or do on a regular basis to stay healthy

what is an effective approach to prescribing medications for patient's from diverse cultural backgrounds

learn about culturally relevant medicinal practices of patients before prescribing medication

what group has been referred to as the invisible minority within healthcare

lesbians

What sort of health disparities do African American and Hispanic in regard to organ transplants?

lower rates of graft survival

what approach is effective in building patient trust

making eye contact with them during visit

patients who are very respectful of providers may respond in which way when prescribed medication

may avoid asking about side effects

what is the result of a patient feeling "judged"

may jeopardize the effectiveness of doctor-patient relationship

why might a patient be reluctant to reveal their sexual orientation to a provider

might not self identify as gay uncertainty about how provider will react fear of being stigmatized or stereotyped

what level of exercise affords the greatest health benefits among sedentary individuals

moderate-intensity exercise

where should medical interpreter sit relative to patient

next to and slightly behind patient and avoid eye contact with physician

what is true regarding the adjustment process during acculturation

older adults tend to experience greater difficulty adjusting to a new culture

how can providers prevent presuming a patient is heterosexual

openly discuss sexual history and relationship status

what might discourage a patient from taking their medication

prescribing complex treatments

during medical history, what is best way to develop a patient's trust and build rapport

provide a setting that is private and safe for disclosure

what is the role of the provider and patient in making health care decisions

provider's responsibility to instruct patient about their condition , but provider must ultimately respect the patient's personal health choices

when providing care for a Chinese patient struggling to become "xianqi liangmu"(good house wife) what approach is best

referral to a Chinese social worker

what is providers role when patient lacks decision making capacity and has someone other than family member designated as surrogate decision maker

serve as a mediator between parties and encourage all groups to work together in the best interest of the patient, consistent with patient's wishes

What factor may contribute to the higher mortality rates seen in the homeless population?

suboptimal access to health care

when motivating patients to quite smoking what approach is most effective

support each patient's small steps and develop a long term plan to quit

How should physicians approach patients with type 2 diabetes and also regularly visit holistic healers?

take a history of alternative medicines used by patients to avoid herb-drug interactions

what may make it more difficult for a lesbian woman to quite smoking

targeting of LGBT community members by tobacco companies- they would support or provide funds for LGBT movements and protests

why might an immigrant be reluctant to participate in direct observed treatment(someone watching to ensure treatment/medication if followed/taken)

the patient may be fearful because of the loss of privacy or cultural misunderstanding or may be undocumented or have undocumented family

when discussing sensitive and personal issues with a patient that may involve significant lifestyle changes, how should the patient's family be involved in the process?

the physician should always decide whether or not to include the family based on the patient's wishes

what factors play the largest role in determining a patient's explanatory model

their culture

What should physicians who provide pharmaceutical samples in their office be aware of?

there may be a significant price difference between samples and the generic version of the medication

Prior to the physical examination of a Muslim adolescent, what should be clarified to the patient and their parent/s

they can express concerns about any part of the exam at any time

What role do ad hoc (as needed) interpreters playin bridging the language barrier

they may be helpful but they lack the clinical foundation and experience of training and experience of trained medical interpreters.

when there is a language barrier what is benefit of using medical interpreter

they offer direct interpretation of the patient's responses

what skills do trained medical interpreters provide in clinical setting

they provide the social and spontaneous interactions with patients like small talk for developing rapport

what is the physician's primary objective when approaching patients about their use of complementary and alternative medicine?

to establish and open discussion about all aspects of the patient's health care

primary purpose of "transtheoretical Model"

to identify where patient is in their thinking

sleep apnea is most dangerous among people in which occupation

truck driving

assimilationists, separationists, and integrationists characterize what model of acculturation

unidimensional model of acculturation

victims of abuse who do not have access to contraception have high rates of...

unplanned pregnancies that result in abortions

what is an effective complement to motivational interviewing

using confidence and importance rating scales

what question is most effective in identifying a patient's ethnicity

what ethnic identity best describes you?

what question is an effective way to elicit a patient's explanatory model of illness regarding Tuberculosis symptoms

what is your understanding of tuberculosis

under what condition is direct observed treatments(someone watching to ensure treatment or medication is taken) most successful

when DOT is carried out in a way that is convenient for a patient

when is it appropriate to prescribe birth control pills for patients in an arranged marriage

when the patient expresses they don't have the desire to get pregnant

what statement is likely to convince a truck driver to change their diet to a healthier one

you should refuel your body just as you refuel your truck, with healthy foods