Nursing Assessment Chapter 11

Which statement by the nurse demonstrates a cultural bias?

"American healthcare is really so much better than that provided by any other country." A bias is based on the practice of applying one's own cultural beliefs and values when interpreting and judging the value of something. A prejudice is disapproving or negative attitude that is not rooted in fact or accurate information. Stereotyping involves a uniform image of one group that is believed by another group or a fixed, overgeneralized belief about a particular group.

The student nurse is aware that culturally competent care is described as which of the following?

Following five constructs of cultural awareness, knowledge, skill, encounters, and desire Culturally competent care requires the nurse to follow the five constructs of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. Not recognizing differences in the same group and believing that everyone in the same culture holds the same beliefs can lead to stereotyping. Believing that one's own culture is the only acceptable truth and superior to all others is called ethnocentrism.

The nurse is being oriented to the oncology unit. Which is a true statement regarding the potential population of this nursing unit?

Hispanic women have higher rates of cervical cancer than white women. Hispanic women have higher rates of cervical cancer than white women. Asian men are less likely to have prostate cancer than African-American men. African-American women are 34% more likely to die from breast cancer. American Indians have higher rates of kidney cancer.

What aspects of culture are relevant when conducting a health assessment on an Asian client admitted for surgery? Select all that apply.

whether there are any existing language barriers alternative medicine practices nutritional or dietary considerations

Which statement by the nurse demonstrates an understanding of the importance that a client's culture plays in the client's health and wellness?

"I need to understand the client's cultural background to best interrupt the client's needs." Culture and ethnicity determines interpersonal communication style, as well as health beliefs, values, and practices. To accurately assess the health needs of clients, the nurse must assess clients within the context of their background. Race is not strongly associated with culture since it is a socially constructed concept. Ethnic values are only a part of what comprises a person's culture. A person's disability does place him or her into a unique culture that can present specific needs.

A patient of African origin comes to the clinic requesting treatment for "bad blood". The nurse is aware that the patient is most likely referring to which disorder?

A sexually transmitted disease People of African origin living in America may refer to blood that is contaminated as "bad blood", and it often refers to sexually transmitted diseases.

A nurse has a regular client who is an immigrant from China and who follows the traditional medical system of that culture. To improve the ability to understand and work with this client, the nurse researches this client's cultural view of health. Which of the following would the nurse most likely discover?

Asian traditions of medicine include Chinese medical practitioners and herbalists who focus on maintaining balance between yin and yang. Native American and Alaska Native traditions include respect for nature and avoidance of evil spirits, along with use of masks, herbs, sand paintings, and amulets. Hispanic traditions include prayers to God and saints for spiritual reparations for sins. African traditions include use of magic, herbs, roots, rituals, talismans, and amulets.

An Afghani woman is admitted to the obstetric unit. While doing a transcultural assessment, how would the nurse individualize questions for this client?

Assess if the client speaks and understands English The most important transcultural assessment to make with this client is whether she speaks and understands English. The nurse would need this information prior to asking for a translator, assuming the client was not allowed an education, or talking only with the husband.

A nurse assesses a 4-year-old boy who experiences gas, a stomachache, and diarrhea after consuming lactose products. The nurse recognizes this data as what type of biological variation?

Biochemical Lactase is an enzyme, which the body uses to digest lactose. Lactose cannot pass easily through the intestinal wall into the bloodstream, so it remains in the intestines. The inability to digest lactose after childhood relates to a mutation. This is called lactose intolerance. The biologic variation for the drug intolerance is called biochemical variation. Pelvic measurements, newborn size, pulmonary function, and body proportion is called anatomic variation. Developmental variation in childhood includes body size, proportion, common clinical measurements, and developmental maturity. Surface variation is comprised of color, secretions, and surface anatomy.

Which of the following statements is true about biologic variation?

Both genetics and environment produce biologic variation. Some aspects of biologic variation affect and are affected by cultural beliefs and behaviors. Genetics and environment, and their interaction, cause humans to vary biologically.

A nurse is working with her first client from a Muslim culture. In working with this client, the nurse quickly realizes that culture has a major impact on health and health care. Which of the following are examples of culture affecting health care? Select all that apply.

Client refuses hospital meal because it contains pork. Client demands that a male nurse be assigned to him. Client requests that he be allowed a time of silence in the afternoons to pray.

An adult African American female client comes to the ED with lower abdominal pain. She is extremely emotional and moving wildly on the gurney. A nurse says to another nurse that the client is "way overdoing it." What should the nurses do to provide better care to this client?

Conduct a cultural assessment to better understand the client's perception of pain and illness.

The nurse is caring for a married female patient from the Middle East who defers to her husband to answer all assessment questions. The nurse understands that it is common in this culture for the male to hold a dominant role in the relationship. What stage of cultural awareness does the nurse display?

Conscious competence Conscious competence is consciously learning about the patient's culture and providing culturally relevant interventions; aware of differences; able to have effective trans-cultural interactions.

A nurse is assigned to care for a client who practices Orthodox Judaism. After reading the client's medical record, the nurse takes time to talk with the client about how to make his hospital stay more comfortable. The nurse admits to the client that she is not familiar with Orthodox Judaism but would like to learn more. The nurse is in which stage of cultural awareness?

Conscious incompetence

A new graduate nurse from a small community college is going to work in an urban setting. She embraces the thought of working in a more diverse setting and wants to learn about different cultures. What behavior is this nurse exhibiting?

Cultural desire Cultural desire is the motivation to engage in intercultural encounters and acquire cultural competence. The starting point of cultural competence is cultural desire.

The nurse knows that she will be caring for a patient from Southern Korea who has been visiting with a family member. The nurse obtains some information about the Korean culture so that she will be able to meet the patients needs. What is the nurse demonstrating?

Cultural knowledge ultural knowledge is the process of seeking and obtaining a sound educational foundation concerning the various world views of different cultures. The nurse has sought information in order to provide culturally competent care by seeking knowledge of the patient's culture.

A nurse is assessing a client from India who complains of panic, sexual dysfunction, fatigue, weakness, and loss of appetite. Which culture-bound syndrome should the nurse suspect in this client?

Dhat Dhat is a culture-bound syndrome of India and includes symptoms of panic, sexual complaints, fatigue, weakness, loss of appetite, guilt, and sexual dysfunction with no physical findings. Latah is a culture-bound syndrome of Malaysia that occurs after a traumatic episode or surprise. Symptoms include an exaggerated startle response (usually in women), screaming, cursing, dancing, hysterical laughter, imitation of people, and hypersuggestibility. Wind illness is a culture-bound syndrome of Asia that features symptoms including fear of wind or cold exposure causing a loss of yang energy. Koro is a culture-bound syndrome of Malaysia and Southeast Asia that features a fear that genitalia will retract into the body, possibly leading to death.

A pediatric nurse is assessing children of various cultures. The nurse notes an African-American child's motor development is better than children of the same age from different cultures. What would the nurse do next?

Document the findings in the client's records. This is a normal finding among African American children as they tend to be ahead of other American groups in motor development. The other children do not need additional testing as they are developing on schedule. The health care provider does not need to be notified of normal findings. A follow up visit is not needed as the child is developing appropriately.

A nurse is assessing a client before administration of an antibiotic. The nurse should be aware that which of the following represents a biochemical variation that may exist between clients of different cultures?

Drug metabolism

A client requests to be cared for by a nurse who is a member of his own culture. The nurse recognizes that which barrier exists in regards to this client's nursing care?

Ethnocentrism

People of all cultures believe that autonomy is a universal right of health care consumers.

False Autonomy is assumed to be a right of all health care consumers in the United States. However autonomy is not an accepted value in many other countries.

A nurse begins an interview with a client who is a Native American. The nurse should recognize that this client will display what type of behavior when responding to questions or engaging in conversation with the nurse?

Look down Native Americans and people from Eastern countries tend to look down to show respect to the person talking. Some African Americans look away when being talked to but give a very high level of eye contact when speaking. Hispanic Americans males, and peoples of some other cultures, tend to stand with the face slightly away from the other speaker. In Latin cultures, it is common for speakers to interrupt one another in conversation.

A nursing instructor is teaching about similarities between Buddhism and Hinduism. The nursing student is correct when stating which of the following?

Many who follow Buddhism and Hinduism are vegetarians. Many who follow Buddhism and Hinduism are strict vegetarians. People of the Jewish religion do not mix meat with dairy products.

Sickle cell disease and other hemoglobinopathies such as thalassemia are often found in persons originating from which geographical regions?

Mediterranean and Africa.

A nurse realizes that when assessing beliefs about health and illness among patients from different cultures, which of the following is true?

Most patients hold a combination of beliefs when it comes to illness. Cultural beliefs and values play a role in how a patient approaches illness and health care. For instance, if a person believes that illness results from evil spirits, then that person will seek out a caregiver who can cast them out. Exercise is not viewed as a positive health behavior among all cultures. People who believe in group healers may not accept Western health care without the involvement of the healer as well.

The nurse is caring for Hindu client. What should the nurse include in the assessment phase?

Need to accommodate for prayer in private The Hindu culture often have shrines that represent their beliefs. These shrines may be in the home or evening in the hospital. Accommodations should be made for the client to pray in a private setting. Muslims have a pray rug and perform ritualistic washing prior to praying. Jewish believers avoid port and port products.

Using Roy's adaptation model, the nurse identifies that the goal of nursing care is to assist the client to achieve what? Select all that apply.

Optimal mental health Physical health Role function Interdependence

Which of the following statements is true?

Pork and wine are forbidden in many ethnic groups for religious reasons. Religious beliefs affect what can and cannot be eaten, such as the prohibition of pork or pork products for Jews and Muslims.

When performing a cultural assessment on a client from another country, what can a nurse do to ensure the client receives culturally sensitive care?

Show genuine interest in the client's culture and personal life experiences. Leininger suggests that the attributes and behaviors of a nurse practicing effective care within the client's cultural context include genuine interest in a client's culture and personal life experiences. They do not include developing a plan of care after talking with the client's family, developing a plan of care based on the nurse's knowledge of the client's culture, or deciding after the focused assessment if a cultural assessment is necessary.

A nursing student is caring for his first patient who is of Latin American descent. Before entering the room, the student reviews how this patient perceives space. The student realizes that when he speaks to the patient, he needs to do which of the following?

Stay close together when talking. Studies show that Asians and Americans tend to keep more space between themselves when speaking. Latins, both from Mediterranean countries and Latin America, stay closer to each other.

Suzie is a 16-year-old daughter in the Hanes family. She is the youngest of five children. She has had a series of illnesses and does not seem to be regaining her strength. She likes school but is falling behind a bit. Her mother is very attentive to her needs but does not seem overly concerned with the continuing pattern of illness. Which of the following is most likely a Hanes family belief?

The family values taking sick roles and caregiver roles. Cultural beliefs and values to assess include beliefs about who serves in the role of healer or what practices bring about healing.

The nurse is caring for a first-time mother and newborn in the postpartum unit. The nurse overhears the new mother ask family members to prepare the nursery and purchase clothing for the baby. What would the culturally sensitive nurse suspect?

The new mother may believe buying infant clothing before the delivery is bad luck

An unresponsive patient comes to the emergency department following an automobile accident with severe internal bleeding. The patient is scheduled for emergency surgery. During history taking, the patient's father states that the patient is a Jehovah's Witness. Which should concern the nurse?

The patient might need a blood transfusion. Most religions accept the use of blood products and blood transfusions, but not Jehovah's Witnesses. That the physician caring for the patient is a male and the nurse is Hispanic should not be a concern for the nurse or the patient. Only having moderate insurance does not interfere with the care and should not be a concern of the nurse.

A nursing student is caring for an older Hispanic adult. The nurse's preceptor asks the student what would be an important assessment to make to provide quality nursing care for this client. What would be the student's most appropriate response?

Transcultural assessment A specific example of a comprehensive nursing assessment that attends to both social and cultural dimensions is the transcultural assessment. A respiratory assessment would be important if the client had a respiratory problem. Mobility and family assessments could be useful, but these aspects can also be addressed through a transcultural assessment.

To determine the sources of strength for a patient, the nurse could ask, "In what ways do they help?"

True

A nurse provides care for an African-American client who experiences tremors, muscle weakness, and nausea. The client's family believes that the client is affected by some kind of black magic. The nurse recognizes this as which culturally bound syndrome?

Voodoo This type of culture-bound syndrome, or voodoo illness, is common in African American-Caribbean groups. It is often referred to as rootwork, hex, fix, witchcraft, a spell, or black magic. This syndrome is based on the belief that illness or death may be caused by an individual, through means of supernatural force. Susto, mal ojo, and empacho are culture-bound syndromes found in some Hispanic groups. Susto is soul fright or magical fright. The symptoms include anorexia, listlessness, and apathy. Mal ojo is an evil eye; the symptoms may appear abruptly and include fever, rashes, nervousness, and irritability. Empacho is a blocked intestine, causing a lump of food to stick to the intestinal wall.

The nurse is to perform an assessment on a newly admitted client from Bolivia, South America who was involved in a minor automobile accident with a local family member. The nurse understands that the first phase of assessment begins when?

When meeting the client for the first time. The first phase of assessment begins with meeting the patient. This involves observation and communication. The meeting itself, nurse-patient communication, and observation include many of the trans-cultural variations of time, space, and communication, and biomedical variations.

A male nurse is caring for an elderly woman from Iran who has become withdrawn and somewhat confused since the nurse has come on duty. When the nurse goes into the room to bathe the patient, she refuses to allow it. The best explanation for her actions would be which of the following?

cultural differences Many cultures restrict touch of females by males. Even male physicians in some cultures are not allowed to treat females. The patient is not showing confusion, depression, or fear in her surroundings but instead is uncomfortable with a male wanting to care for her.

A nurse is aware that which of these represents a biochemical variation that may exist between clients of different cultures?

drug metabolism Drug metabolism differences, lactose intolerance, and malaria-related conditions, such as sickle cell disease, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and Duffy blood group, are considered biochemical variations. Risks for osteoporosis and skin cancer are examples of a ethnic disease variation. Motor development appears to be related to both genetics and environment and is a developmental variation.

A culture-bound syndrome seen in the African American community is

falling out. A culture-bound syndrome seen in the African American community is falling out or blacking out. This is a sudden collapse preceded by dizziness, spinning sensation. Eyes may remain open but unable to see. May hear and understand what is happening around them but unable to interact.

Risk factors for mental disorders

may be specific to an ethnic group. Knowing what issues the culturally different client may have at work and what high-risk behaviors are common to the cultural group, as well as the environment from which the client comes, can give clues to current health status.

The nurse and a Hispanic client are developing a transcultural nursing care plan related to hypertension. The nurse will include in the plan

nutritional information specifically for a Hispanic client. Compare the nutrients of foods not usual in the United States with nutrition charts to understand how healthy a diet is, especially with regard to diseases such as diabetes mellitus. It is very difficult to get a client to change usual dietary habits drastically, even with knowledge of the interaction of diet and disease.

A nurse is caring for a patient who is an American Indian. When working with this patient, the nurse consider that the patient believes which of the following as true about eye contact?

shows disrespect White Americans when talking to each other expect a high level of eye contact. People from Eastern countries and Native Americans tend to look down to show respect for the person talking.

A nursing student realizes that which of the following is an important variation of communication?

silence

An Asian patient has been admitted to a medical floor with a diagnosis of pneumonia. Upon admission the patient is very talkative and friendly to the nurse. When the nurse approaches the patient's bed to listen to his lung sounds, the patient becomes very quiet and starts to pull away. The nurse realizes that this is because of the patient's perception of which of the following?

space Studies show that Asians and Americans tend to keep more space between them. In this case, as long as the nurse kept a distance, the patient was comfortable. Autonomy, silence, and time do not play a role in this particular scenario.

The most effective way for a nurse to learn about an ethnic group within the community in which he/she practices is

spend time with a variety of individuals of that ethnic group. Repeated face-to-face encounters help to refine or modify the nurse's knowledge of the culture. The nurse must seek out many such encounters with the desire to understand more about the culture.

When performing a cultural assessment, an important point to remember would be

that definitions of family differ