Ch 4 and Ch 6
Julie is a 42-year-old wife and mother who has recently experienced a mastectomy for breast cancer. The nurse enters the room to check vital signs and sees tears in the eyes of Julie and her husband. Which of the following statements by the nurse reflect accurate understanding of approaches to communication in a therapeutic relationship? a "I know this is a difficult time for you and your family. It is probably best if we wait and talk about your concerns when you a little stronger." b "I think it will be helpful if you both remain hopeful and stay focused on the positive." c "I know this is a stressful time for you; would you like to visit with the chaplain?" d "You seem to be troubled, which is understandable. In what ways can I be the most helpful to you at this time?"
ANS: D Feedback a Waiting to talk about concerns may not be the family's choice. It may be difficult to have patient and husband focused on this topic in the future. b Encouraging a family to stay hopeful and positive does not acknowledge their current experience. c Referring the family to the pastor may not match their spiritual needs, and the chaplain may not have the information they need at this time. d Calling attention to their distress acknowledges their experience. Allowing the family to indicate their priority concerns at this time and offering assistance in the area the family chooses allows them to direct the conversation. This statement allows the family to gain trust in the nurse.
Which of the following changes in population demographics need to be taken into consideration in providing culturally sensitive nursing care for families? a Increase in migration patterns of different ethnicities b Increasing recognition of GLBT families c Increase in single parent families d All of the above
ANS: D Rationale: All demographic shifts should be considered when providing culturally sensitive nursing care for families, including migration patterns and changes in family structure.
Which area is typically not included in the Assessment of Culturally Distinct Behavior (according to Giger and Davidhizer)? a Communication b Social organization c Time d Developmental stage
ANS: D Rationale: Communication, social organization, and time are a part of the Assessment of Culturally Distinct Behavior (according to Giger and Davidhizer). Developmental stage is not a part of the cultural assessment, although it should be taken into consideration
Motivational interviewing techniques reflects which of the following premises? a Asking and listening are core communication skills needed when using motivational interviewing techniques. b This type of communication relies on the nurse's identification of the behavior needing to be changed. c This type of communication requires a nurse who can be directive and clear. d This type of communication is best used with an individual approach, rather than a family.
ANS: A Feedback a Being able to actively listen and asking the client to identify the changes are guiding principles to motivational interviewing. b For an effective outcome, the patient or family, rather than the nurse, must identify the necessary change. c A nurse's communication technique is more guiding when motivational interviewing communication is used. Directing will create more resistance. d A family can participate in a motivational interview.
Which of the following is an example of ethnocentric thinking? a Freedom is an important factor for individual development. b Human interactions are complex. c There is more than one way to look at a problem. d No two families are the same.
ANS: A Feedback a In ethnocentric thinking, one sees her/his own worldview or values as applicable to everyone else. The concept of freedom is not universally defined or valued. b Understanding that complexity is part of human interactions minimizes the likelihood of ethnocentric thinking. c In ethnocentric thinking, people only consider one way of looking at a problem. d In ethnocentric thinking, people often generalize their own experience to others and assume that all families are the same.
Which of the following is the best rationale for a nurse to spend time communicating with a family member of a hospitalized patient? a. The nurse often has information that needs to be shared with a family member who is a primary social structure caring for an individual. b. A nurse's communication can supports the nurse's position of power in the health-care system caring for an individual. c. Communication with family members is critical to increase a nurse's satisfaction with the role. d. Nurses use communication to develop an efficient interprofessional team that exchanges information.
ANS: A Feedback a The family is the primary social structure that cares for family members and will be involved in caregiving when the individual returns home. b Nurses maintaining power over a family does not support a partnership. c Satisfaction with nurse's role does not offer the best rationale for communicating with families. Family satisfaction and family care are optimal goals. d The interprofessional team communication does not fully address the family role in caring for an individual. The efficiency of the team is not the best rationale for family communication.
A nurse is caring for a family with apparent language barrier. The nurse is preparing to discharge the patient who has been recently started on insulin and just learning to administer the medication and follow the dietary regime. Which of the following statements by the nurse reflects an understanding of communication in this context? a "I know this is a great deal of information to learn as you prepare for Mr. H to return home. If it's okay with you, I will come back later and we can review the information again." b "You probably have many questions. But they will get answered as you read these materials." c "Families have different ways of approaching the chronic disease of diabetes, but it is important for your family to understand the right way to approach this disease." d "I know it is difficult for Mr. H to accept this diagnosis, but it needs to be his disease to manage, rather than depend on you as his family."
ANS: A Feedback a This response demonstrates understanding that a new diagnosis and treatment regime may require repetition of information and time for acquisition of knowledge. b Assuming that a family can read and understand written materials does not consider health literacy. c Being directive with the way to manage an illness does not reflect an understanding of a family's need to partner with a nurse in identifying the directions. d Illness is a family experience and affair. The family is a system where an illness impacts the entire family and needs to be addressed by family system.
The Juarez family includes Maria, age 76, Juan, age 72, and three adult children. Maria has been managing a diagnosis of heart failure for approximately 10 years. Documentation suggests the family has had a great deal of stress with recent hospitalizations and caregiving in their home. The adult children voice their concerns about Maria's decision to complete an advanced directive. Which of the following demonstrate an insufficient understanding of family-focused nursing care and communication? a. A nurse should make a statement such as, "Your family has had a great deal of distress lately; why don't you just let Maria make her own decisions." b. A nurse's questioning techniques may help identify the family's beliefs and understandings about advanced directives. c. A nurse should make a statement such as, "Your family has done a good job of caring for each other during this lengthy illness." d. A nurse should attempt to clarify misunderstandings and share accurate information about the health status of the patient.
ANS: A Feedback a. This statement fails to recognize the role of a family in decision-making. Even though maintaining patient autonomy is important, a family-focused nurse should also address the family's concerns. b. This statement is correct because understanding the family's beliefs will require questioning techniques to provide family-focused nursing care. c. This statement is correct because family-focused care commends a family for their strengths. d. This statement is correct because family-focused care provides information about the status of an ill family member to a family.
Which of the following are assumptions of the Health Belief Model? Select all that apply a Individuals interact with the environment, transforming it and being transformed in the process. b Health professionals must initiate the changes in order for change to occur. c Individuals actively seek to regulate personal behaviors. d Healthcare professionals are part of the interpersonal environment that influences people across their lifespan.
ANS: A, C, D Rationale: The key person for making change is the patient.
Which of the following is the most important reason for knowing "family stories"? a It is essential in relationship building. b It helps the nurse predict future care needs. c It is considered a best practice in customer service. d None of the above.
ANS: B Feedback a Although hearing a patient's story can help establish a relationship , the most important reason for assessing them is to get insights in possible future needs. b Family stories relate past experiences that can help predict future needs. c Although hearing a patient's story can help increase patient satisfaction , the most important reason for assessing them is to get insights in possible future needs. d Although hearing a patient's story can help increase patient satisfaction and establish a relationship, the most important reason for assessing them is to get insights in possible future needs.
Which of the following is the most important reason for offering culturally sensitive care? a To make patients feel comfortable b To offer safe care c It is required by law d It increases patient satisfaction
ANS: B Feedback a Even though making a patient feel comfortable is important, safety is of higher priority b Patient safety is a cornerstone of nursing practice. c While some aspects of cultural sensitivity, i.e., provision of interpreters for individuals who are deaf, may be required, most elements of culturally sensitive care are not mandated by law. d Even though patient satisfaction is important, safety is of higher priority.
Effective communication can assist a nurse to achieve which of the following desired health outcomes? a Readmissions with chronic disease exacerbations. b A nurse-individual-family relationship that supports quality nursing care. c Improved written documentation of errors in nursing. d Decrease in time spent communicating with difficult families.
ANS: B Feedback a Readmissions are not a desired health outcome. b Nurses who practice family-focused care recognize the importance of a relationship in providing quality nursing care for the individual and family. c Improved documentation of errors is not the highest priority for health outcomes. d Decreasing time communicating with families is not a goal of family-focused care.
Which of the following theoretical models would best help explain why a family might bring in their own "hot" and "cold" foods for healing after a birth? a The Family Health Model b The Sunrise Model c The Health Promotion Model d The Health Beliefs Model
ANS: B Feedback a The focus of the Family Health Model is more on the role of family than the health needs of the individual. This answer is not wrong, but not the best answer. b The Sunrise Model helps nurses understand the importance of understanding and respecting patients' cultural health beliefs. c The Health Promotion Model focuses on how individuals can achieve changes that promote health; the focus is less on culturally based nutritional habits d The Health Beliefs Model focuses on beliefs that people have regarding their health and how they can make changes. This model is useful for patient with illnesses that require lifestyle changes (e.g., diabetes).
Which of the following factors is likely to impact nursing care related to aging populations? a There is a surplus of available nursing homes. b More people will find themselves as the "sandwich generation," caring for parents and children at the same time. c Most elderly people are sick, frail, and dependent on others. d All of the above.
ANS: B Feedback a There is not a surplus of available nursing homes. Many homes have waiting lists for admission. The lack of available spaces will impact nursing care related to aging populations. b Nursing care for aging populations will be affected by the growing "sandwich generation" of people caring for parents and children at the same time. c While elderly people may be sick, frail, and dependent on others, this is not a characteristic of most elderly people. d There is not a surplus of available nursing homes and many elderly people live independently and are not sick, frail, and dependent on others. It is true that nursing care for aging populations will be affected by the growing "sandwich generation" of people caring for parents and children at the same time.
Which of the following are reasons to involve an interpreter when working with a patient who speaks a different language than the nurse? Select all that apply a It is required by law. b In order to make an accurate assessment. c In order to develop a trusting relationship. d An interpreter is likely to provide the intent of the discussion
ANS: B, D Rationale: Not having all the assessment data can lead to misdiagnosing a patient and thus puts the patient at risk. Family members can provide observations of behavior and information about physical, emotional, and mental status of individual members.
A nurse is caring for a male who has been informed of a prognosis of only several months before death. He wants to return to his home with hospice care. He has a wife and two daughters who do not support this decision. Which of the following communication principles should guide the nurse during this family situation? a A nurse guides families by staying focused solely on the patient's needs and wishes. b Families need to be informed that they are unable to provide the quality care needed in the home. c Exploring the family's beliefs about hospice, death, and their role can help families make decisions. d Helping family members understand the benefits of a patient dying at home produces the best outcomes.
ANS: C Feedback a At times the nurse guides a family by helping a family understand the unique needs and wishes of the entire family. This often helps resolve family conflicts and increase awareness of multiple perceptions in a family. b Taking the approach of telling a family the action to take limits their choices and support for a decision. c Examining families' beliefs is important to family decision-making. The unique beliefs of the family members must be explored for a family to reach consensus. d At times a family member's choices related to end-of-life care are best met at home, and at other times they are best met by the health-care system.
Which of the following statements would NOT be considered a characteristic of personal bias or stereotype? a Ideas that are oversimplified in regards to a specific group b Views that one group holds about another group c Bias can be a useful starting point to offering culturally sensitive care d Bias is hard to identify in one's self
ANS: C Feedback a Ideas that are oversimplified in regards to a specific group is a characteristic of bias or stereotype. b Views that one group holds about another group is a component of bias or stereotype. c Bias is an ineffective starting point to offering culturally sensitive care because it does not allow for open communication. d Often, individuals are not aware of biases or stereotypes, and such beliefs can be difficult to identify.
Which of the following statements describe accurate information about family-focused communication? A nurse's communication with a family: a. Usually focuses on the individual family member with an illness. b. Usually begins with a nurse sharing personal information. c. Aims to develop a caring relationship that sees the individual and family as the unit of care. d. Most often requires a nurse to determine the direction for family-focused communication.
ANS: C Feedback a. Family-focused communication addresses a family member with an illness as well as the family. b. A nurse sharing personal information sets a tone of the nurse being focused on self, rather than the family. c. Family-focused communication addresses the need for nurses to care for individuals and the family. d. The family often identifies the direction and priority for communication.
Which of the following factors of a health-care system foster effective family-focused communication? a An environment that uses complex technology. b A nurse's stance that health-care providers maintain power in a relationship. c Educational materials that consider the health literacy of families. d A family's fears and anxiety about an individual member's illness.
ANS: C Rationale: A technological environment, a nurse's stance of power, and family's concerns in a health-care system introduce possible barriers to communication. Written documents and education materials that consider health literacy have the opportunity to provide information and reduce anxiety.
Which of the following reflect inaccurate assumptions of family-focused care? a Communication in a family and health-care setting can influence health. b Effective therapeutic communication is at the core of family-focused care. c Nurses can facilitate communication among family members to support family health. d Family members can be expected to reach out to nurses when they need information.
ANS: D Feedback a Communication among family members and in a health-care system can influence health and outcomes. b Therapeutic communication is a basis for family-focused care. c Family focused nursing care facilitates family communication that supports health d A nurse must expect to initiate an interaction with a family that is experiencing distress and concerns during times of family health concerns. Families need nurses to initiate a partnership and relationship.
The nurse is beginning a shift caring for a 26-year-old adult female who has just been admitted to the critical care area of a hospital with a pneumonia and respiratory failure. The nurse is told that the patient's parents are anxiously sitting in the waiting room. Which of the following statements best reflect a nurse's understanding of the communication needs of the parents? a "I will hurry with my assessment of your daughter so you can spend time with her after I leave." b "Why don't you go have a cup of coffee while I assess your daughter?" c "Since your daughter is an adult, I really can't share any information with you about her condition." d "All of this is probably frightening for you. Would you like to come with me into the room so I can explain equipment and information to you while I care for your daughter?"
ANS: D Feedback a Leaving the family alone in the room with a newly admitted patient fails to take advantage of the opportunity to build a family partnership and nurse-family relationship. b Suggesting a family leave during a time when they are anxious does not minimize their uncertainty or address their concerns. c Confidentiality can be maintained while informing family members and exchanging information. d A nurse can anticipate distress in family members when there is an acute illness. The nurse can plan to include the family, invite the family, and explain the environment to minimize the anxiety.
A nurse is visiting a patient who has been discharged to home for a follow-up evaluation. The patient was diagnosed with diabetes many years ago. She has been hospitalized multiple times with infections and renal insufficiency. She now needs dialysis on a regular basis. Which of the following actions would support a therapeutic relationship between the nurse and family? a The nurse needs to limit the time given to the family to tell their story to stay focused on the patient. b The wound care and weight assessments are the priorities during this visit. c Using linear questioning techniques will help the family share their understandings of the situation. d Spending time assessing the patient's symptoms and the family's experiences will produce best outcomes.
ANS: D Feedback a Technical skills and relationship skills can be blended during nursing care. Limiting the time with the family may disrupt the future relationship. Telling the illness story may give the nurse essential information needed for future care. b The wound and weight gain are a priority, but family information may also be necessary at this time to determine future directions. c Circular questioning techniques are more likely to help a family share their understandings. d Family-focused care identifies the patient and the family as the recipients of care. Assessing the patient's symptoms and the family's experience creates a therapeutic conversation and relationship.
Which of the following is an example of cultural humility? a A nurse familiarizes herself with the requirements of kosher food. b A nurse believes that giving Jell-O to all patients after surgery has no cultural implications. c Patients and family members are discouraged from praying on the floor to protect their hygiene and safety. d All of the above.
ANS: D Feedback a Understanding a patient's cultural nutritional requirements is an example of cultural humility. b Jell-O contains animal products/pork and is not eaten by certain cultures. c Religious practices may have great significance and importance for patients. If the nurse believes these are problematic, solutions must be sought agreeable to all rather than simply discouraging practices. d Understanding a patient's cultural nutritional requirements is an example of cultural humility. The other answers support the nurse's own beliefs rather than focusing the patient's needs.
Which of the following areas of cultural behaviors would a nurse be assessing if using the transcultural nursing assessment tool? a Communication, social organization, biological variation, and socioeconomic factors b Communication, time, biological variation, and socioeconomic factors c Space, time, biological variation, and socioeconomic factors d Communication, social organization, time, and biological variation
ANS: D Rationale: Communication, social organization, time, and biological variation are elements of the transcultural assessment tool.
According to Taylor, which of the following is not considered to be one of the three levels of culture? a Cultural tradition b Subculture with shared traits in a different society c Cultural universals d Socioeconomics
ANS: D Rationale: Cultural tradition, subculture with shared traits in a different society, and cultural universals are all considered by Taylor to represent levels of culture. Socioeconomics is important but not considered by Taylor to be part of the levels of culture.
Which of the following resources is the most important source of cultural information to understand the culture of a patient and family? a CIA World Factbook b Multicultural Resources for Health Information c Office of Minority Health: Cultural Appropriate Services d None of the above
ANS: D Rationale: The family and patient are the most important source or information. Sources of information, such as websites and books, can support understanding but should not be used as primary source
Which of the following factors would be the least likely to represent a cultural factor? a Gender identity b Family of origin c Religion d IQ
ANS: D Rationale: While IQ measurement can be influenced by culture, gender identity, family of origin, and religion all represent stronger cultural factors.
