Chapter 21: Ethnicity and Cultural Assessment Questions

7. The most important aspect of providing culturally competent care is exhibited through what action by the nurse? a. Seeking to understand individual patient customs, beliefs, and values b. Planning collaborative care with a variety of health care professionals c. Providing similar care for all patients regardless of their background d. Transferring patients to more culturally conducive areas more quickly

ANS: A Assessing and listening to each patient's customs and beliefs is the most important way to provide culturally congruent and patient-centered care. Collaboration with other professionals is secondary to needs assessment. Treating everyone identically or transferring patients with diverse cultural backgrounds off of the unit does not meet individualized, culturally sensitive standards of care.

3. Which action by a health care facility would demonstrate a commitment to providing culturally competent care? a. Providing continuing education events focused on delivery of linguistic services b. Referral of cultural diverse patients for psychiatric counseling to help them communicate more clearly c. Providing signage in English to help patients and families navigate from one department to the next more easily d. Delegation of all patient and family care to health care professionals that are of the same ethnicity

ANS: A CLAS Standards for Health Care recommend that health care organizations ensure that staff at all levels receive continuing education in linguistically appropriate services. Psychiatric counseling is unnecessary to overcome most communication challenges. Signage needs to be provided in multiple languages commonly spoken in the health care facility in order to better inform and direct patients who do not speak English. It is impossible and unnecessary to delegate all care to persons of like ethnicity.

20. The nurse is caring for a patient from a different culture. After assessing the patient and formulating the care plan, what action by the nurse is best? a. Review the care plan for acceptance by the patient. b. Delegate appropriate tasks to unlicensed assistive personnel. c. Go over the care plan with the charge nurse. d. Begin implementing the planned interventions.

ANS: A Care plans, with their goals and interventions, should always be validated by the patient. This is especially true when the patient is from a different culture than the nurse. The charge nurse may or may not need to view the care plan, but after validation with the patient, the nurse can begin implementing the plan, including delegating appropriate tasks.

17. The nurse is caring for a patient from a different cultural background. What action by the nurse best demonstrates cultural maintenance? a. Assist the patient with a healing ritual. b. Teach the patient a heart healthy diet. c. Instruct the patient on monitoring blood glucose. d. Discuss what self-care activities the patient is willing to do.

ANS: A Cultural maintenance maintains and preserves relevant cultural care values pertaining to health care. Assisting the patient with a healing ritual important to him/her is an example. Teaching a heart-healthy diet and blood glucose monitoring falls into cultural care repatterning. Discussing what changes the patient is willing to accommodate is an example of cultural care accommodation.

7. The new nurse tells the preceptor that since she is not prejudiced against ethnic minorities, they will not be discriminated against while in the hospital. What statement by the preceptor is most appropriate? a. Discrimination can occur at the societal level. b. The hospital needs more nurses like her. c. Prejudice and discrimination are not the same thing. d. There is always some discrimination against minorities.

ANS: A Discrimination can occur at the societal level, so even though this nurse is not prejudiced, patients from ethnic and cultural minorities can still suffer from discrimination. The other answers do not explain how discrimination can occur.

5. What response is most appropriate for the nurse if a patient prefers to seek acupuncture for pain relief before taking prescribed medication? a. Recognize that alternative forms of treatment can be effective. b. Require that the patient take the ordered pain medication. c. Refer the patient for professional pain relief counseling. d. Have the patient's family get the patient to take the medication.

ANS: A Many health care professionals and patients recognize the effectiveness of alternative therapies, which are more typically associated with Eastern medicine. Patients should not be forced to take medication against their will. Counseling is unnecessary in this case, and seeking the family's help in convincing the patient to take the prescribed medication is not the best option.

12. A nurse is working with a patient who has limited English proficiency. What action by the nurse is best? a. Use a qualified interpreter. b. Ask family members to translate. c. Use drawings and pictures. d. Speak in simple sentences.

ANS: A National Culturally and Linguistically Appropriate Standards (CLAS) from the U.S. Department of Health and Human Services identify methods for providing culturally competent care and guidelines for their implementation. This includes using qualified interpreters when working with non- or limited-English speaking persons. Using a family member to interpret can upset the balance of power within the family, cause embarrassment, and lead to inaccuracies. Using drawings and pictures or speaking in simple sentences is not as effective as using an interpreter.

9. What action by a nurse would indicate an understanding that foreign-speaking patients experience a clash of more than one culture when admitted to a health care facility? a. Explaining medical terms and verifying that the patient understands b. Sharing written patient information pamphlets for the patient to read c. Orienting the patient's family to the hospital lounge and visiting hours d. Contacting the pharmacy for generic and brand name medications

ANS: A Nurses need to be aware that three cultures intersect in culturally competent care; the nurses and patient's cultures as well as health care culture. Explaining medical terminology and verifying understanding demonstrates an understanding of this phenomena. Sharing pamphlets may not meet patient needs if they are unable to comprehend the written material. Orienting families and calling the pharmacy does not relate to exhibiting cultural competence.

16. A patient refuses to take his blood pressure medication because "I feel totally fine and don't need it." What action by the nurse is best? a. Assess the patient's time orientation. b. Document the patient's non-compliance. c. Educate the patient about the medication. d. Warn the patient about possible complications.

ANS: A People with a present time orientation typically live in the "here and now" and may not see the benefit of adhering to medical regimens when they are not symptomatic. The nurse should assess the patient's time orientation. Documentation and education are both important but are not likely to secure the patient's cooperation.

10. A nurse is caring for a refugee patient who wants the community shaman to perform a healing ritual at the bedside. What action by the nurse is best? a. Work with the patient to allow the shaman to perform the ritual. b. Investigate whether the ritual will harm the patient. c. Check to see if the ritual breaks laws or policies. d. Offer to call the hospital chaplain instead.

ANS: A Rituals are deeply powerful and have great meaning for individuals who practice them. The nurse should work with the patient to facilitate the ritual. Investigating the ritual for patient harm or illegality is ethnocentric; the nurse's first thoughts should not be on the potential negative aspects of a deeply meaningful activity. The patient has not requested the chaplain; offering to call the chaplain shows ethnocentrism and lack of respect for the patient. While working to facilitate the ritual, the nurse will discover if any aspect of it might be problematic and can collaborate with the patient and shaman to resolve the situation (e.g., if lighted candles are needed but prohibited by policy and fire code).

4. A charge nurse works on an inpatient unit in a diverse city. Knowing some generalizations about different ethnic groups, which action is best? a. Assign a female nurse to a female Muslim patient. b. Allow the family to stay when the Russian patient is told he has cancer. c. Start a meeting with a Hispanic family promptly on time. d. Have the Amish patient watch patient education podcasts.

ANS: A Some generalizations can be made about cultural groups; however, the nurse must remember that each person is an individual who needs individualized assessment and care. Given that caution, Muslims often prefer same-sex caregivers. Russians typically do not share bad news with the patient. Hispanics often view time and punctuality with more flexibility than other groups. The Amish usually avoid technology.

1. Which factors are biological variations that should be assessed by the nurse when conducting a transcultural assessment? (Select all that apply.) a. Susceptibility to illness b. Body frame and structure c. Existence of genetic disease d. Social and work time orientation

ANS: A, B, C Susceptibility to illness, body structure, and the presence of a genetic disease are all biological variations that should be assessed during a transcultural assessment according to Giger and Davidhizar. Social orientation and work orientation are not biological phenomena.

2. The nurse is caring for a surgical patient who speaks only Mandarin Chinese. The nurse will (Select all that apply.) a. consider the body structure of the patient for rehabilitation needs. b. use the translation services of the institution for communication of the care plan. c. explore the cultural practices for foods, eye contact, and body space for care provision. d. ask a family member to translate.

ANS: A, B, C The nurse should take into account the patient's body structure and cultural practices when providing care. Use of a professional interpreter is necessary if the nurse and the patient do not speak the same language fluently. Avoid translation of medical information by a patient's family members or friends to ensure privacy and accuracy of essential, personal information.

1. The student studying culture learns that which are characteristics of all cultures? (Select all that apply.) a. Integrated systems b. Shared c. Learned d. Symbolic e. Inherited

ANS: A, B, C, D Cultures are learned, symbolic, shared, and integrated. Since culture refers to patterns of beliefs, actions, values, and ways of life that are taught, they are not inherited.

2. The nurse understands that which are important in the process of developing a cultural identity? (Select all that apply.) a. School b. Church/religious institution c. Family d. History e. Community

ANS: A, B, C, E Many institutions and groups, both formal and informal, assist an individual in developing a cultural identity, including school, religious institutions, family, and community.

4. The nurse is using Giger and Davidhizar's Transcultural Assessment Model to gain information about a patient from an unfamiliar culture. What questions does the nurse ask that are relevant to this mode? (Select all that apply.) a. "Who would you like present to help answer questions?" b. "What do you believe caused your current illness?" c. "How important is planning for the future to you?" d. "Why don't you want to shake my hand?" e. "What activities would you do to control your health?"

ANS: A, B, C, E The Giger and Davidhizar Transcultural Assessment Model looks at communication, space, social orientation, time, environmental control, and biological variation. The questions all address these factors; however, asking why the patient does not want to shake the nurse's hand sounds judgmental and "why" questions are a communication barrier.

13. The nurse is working with a patient from an unfamiliar culture. After assessing the patient and the patient's cultural beliefs related to health care, what action by the nurse is best? a. Create a nursing plan of care for the patient. b. Recheck cultural beliefs with the patient. c. Use a standard plan of care for consistency. d. Have an interpreter validate the information.

ANS: B According to Leininger and McFarland, the nurse should recheck assumptions and findings related to culture with the patient. This is an important step prior to creating a care plan. A standard plan will not be culturally congruent. The stem does not indicate that the patient has limited English, but if he did, using an interpreter would be important.

11. A new graduate nurse tells the manager that she does not believe she needs more in-service training on culturally congruent care because she already recognizes that there are significant differences among cultures to take into account when providing care. What response by the manager is best? a. "You have done a great job becoming culturally competent." b. "Providing culturally congruent care takes ongoing work and effort." c. "That is a great start, but be sure to sign up for the in-service." d. "Cultural sensitivity and cultural competence are not the same."

ANS: B Cultural sensitivity is the recognition that there are profound differences among cultures that can affect health care. But in order to provide culturally congruent care, the nurse must do more than just recognize these differences. This is an on-going process. Option B is the only one that provides useful information to the nurse as to why she must continue to work on this aspect of her profession.

1. A faculty member is contrasting culture and ethnicity to students. Which statement is most accurate? a. Culture is biologically determined; ethnicity is chosen. b. Culture is socially transmitted; ethnicity is identification with a group. c. Culture is a chosen identity whereas ethnicity is biologically based. d. Culture and ethnicity are similar constructs used interchangeably.

ANS: B Culture refers to the learned, shared, and transmitted knowledge of values, beliefs, and ways of life of a particular group that generally are transmitted from one generation to another and influence the individual person's thinking, decisions, and actions in patterned or certain ways. Ethnicity is the person's identification with or membership in a particular racial, national, or cultural group and observation of the group's customs, beliefs, and language. The words may be used interchangeably by some people, but this is not correct.

15. A patient in the emergency department needs an emergency operation. The patient refuses to consent and wants the nurse to call a respected elder in the community for consent. What action by the nurse is best? a. Explain that this violates privacy laws. b. Call the elder to get consent for the operation. c. Tell the woman she has the right to consent. d. Arrange for admission without the operation.

ANS: B In some cultures, decisions are made by men or community leaders. Although the patient may have the legal right to consent, if she comes from a culture in which gender and/or social roles do not permit decision making, she will likely refuse to consent. The best action is for the nurse to contact the elder and have him participate in the decision-making process per the patient's wishes. If the patient has given permission to share the information, doing so does not violate privacy laws. Admitting the patient without the operation does not help her medically.

3. The student learns that which item is the most important symbolic aspect of culture? a. Flags b. Language c. Art d. Music

ANS: B Language is the most extensively used set of symbols in a culture. The other items are important symbols but are not as important as language because words are used to represent objects and ideas.

19. A home health care nurse is visiting the home of a patient whose culture is totally unfamiliar to the nurse. What action by the nurse is best? a. Perform nursing care with a high degree of professionalism. b. Watch family interaction patterns closely and try to copy them. c. Tell the family you need to learn about their culture. d. Apologize after performing tasks that make the patient uncomfortable.

ANS: B Nurses should observe family dynamics carefully, including communication, and try to copy them as much as possible. For instance, if the family does not make eye contact with the nurse, he/she should avoid trying to make direct eye contact with the family. The other options are reasonable, although telling the family you need to learn about their culture may place the burden of educating the nurse on them.

8. What does the nursing student learn about race? a. It is biologically based. b. It is a social construct. c. It is chosen by the person. d. It helps establish superiority.

ANS: B Race is often thought to be inherited and biologically based, but this is not true. Race is a social construct that is used to group people together on the basis of common physical characteristics, heredity, or common descent. People are placed into racial categories by the larger society. One race is not superior to any other.

6. A nurse is caring for a homeless patient and tells the manager, "I will make sure he doesn't steal food from our nourishment center." What action by the manager is best? a. Tell the nurse she is right to monitor the patient's activity. b. Inform the nurse that not all homeless people will steal. c. Educate the nurse that hunger might make the patient steal. d. Remind the nurse to initiate a social work consultation.

ANS: B This nurse is guilty of being prejudiced against the patient, who is a member of the homeless culture. Although hunger might drive a homeless person to steal, prejudice leads the nurse to believe that all homeless people steal. The manager informs the nurse of this information, gently pointing out the nurse's bias. A social work consultation may be a good idea for the patient but does not address the prejudiced nurse.

3. The nursing student learns that which are correct regarding acculturation and assimilation? (Select all that apply.) a. Assimilation is forced entry into a different culture. b. Acculturation depends on first-hand contact between groups. c. Acculturation results in changes to the minority culture only. d. Assimilation can occur at the group or individual level. e. Assimilation causes a minority group member to blend into the majority group.

ANS: B, D, E Acculturation occurs from first-hand contact between a minority group and the majority cultural group and can result in changes to one or both cultures. Assimilation occurs when members of a minority group blend into the majority group and can occur at the group or individual level. Assimilation is not a forced change.

14. A patient from an unfamiliar culture appears disinterested when the physician is telling her about options for treatment of a new diagnosis. After the physician leaves, the nurse attempts to talk to the patient and notices the same behavior. What action by the nurse is best? a. Give the patient the information in writing to read later. b. Ask the patient about the meaning of the patient's behavior. c. Investigate nonverbal communication patterns of this group. d. Leave the patient alone to come to terms with the diagnosis.

ANS: C Communication differences can lead to misunderstandings and possible medical errors. Many cultural groups have verbal and nonverbal communication patterns that differ from other groups. Variations can occur due to personal or social situations. The nurse should attempt to learn about the cultural group's communication patterns. Giving the patient written material and leaving the patient alone do not help solve this dilemma, and the patient may not have the literacy skills to understand the material. Asking the patient the meaning of behavior is unlikely to elicit useful information because the patient herself may not totally understand it or be able to articulate it. This may be a deeply seated cultural custom that is simply part of who the patient is.

21. A patient has hypertension and is on a very-low-sodium diet. However, the patient is going to celebrate an important religious holiday soon that includes many food items high in sodium. What action by the nurse is best? a. Tell the patient you are so sorry she can't have any of these foods. b. Consult with the prescriber about increasing the blood pressure medications. c. Collaborate with the patient and dietitian to include some of these foods. d. Tell the patient eating these foods once won't hurt her condition.

ANS: C Food has important meaning to many people, especially when they are part of celebrations, religious, or cultural activities. The nurse should collaborate with the patient and dietitian and try to find ways to incorporate some of these items. The nurse should not just tell the patient she can't have them. Increasing the medications or encouraging the patient to be non-adherent could lead to adverse outcomes.

6. Which strategy would most help an English-speaking nurse to communicate with a patient for whom English is a second language? a. Use acronyms when referring to community organizations. b. Abbreviate medical terminology as much as possible. c. Slow down when speaking to articulate more clearly. d. Speak more loudly when the patient misunderstands.

ANS: C Many people speak their native language very quickly, which can be confusing to others for whom it is a second language. Slowing down speech helps with articulation and clarity in speaking. Use of acronyms or abbreviations is extremely confusing to individuals who are not native to a language or are just learning it. Speaking more loudly will not help a person understand a foreign language.

4. Which action by the nurse is essential to providing culturally congruent care? a. Follow established patient interview guidelines without variation. b. Understand that environmental context need not be documented. c. Recognize one's own personal cultural heritage, patterns, and biases. d. Assume that cultural values are identical for all members of one family.

ANS: C Recognizing one's own personal biases and cultural norms is essential to providing culturally congruent care according to Leininger and McFarland. When assessing culturally diverse patients, it is essential for the nurse to adapt assessment questions in a manner that is more understandable to the non-English-speaking patient. Nurses should always note the environmental context in which patient interactions take place, consistently documenting the location of assessment. Beliefs and values of family members may vary significantly.

5. A nurse has been told he has many obvious stereotypes about a specific cultural group. What action by the nurse is best? a. Ask to not care for members of this cultural group. b. Ask to take care of as many members of this group as possible. c. Begin to educate himself on aspects of this cultural group. d. Vow to not allow his stereotypes to show when providing care.

ANS: C Stereotypes are fixed ideas, often unfavorable, about groups of people. They occur as a consequence of being unwilling to gather all the information needed to make fair determinations. The nurse would benefit most from beginning to learn about this cultural group. Caring or not caring for members of this group will not help him obtain new information. The nurse should not let stereotypes show, but this is not the best option.

2. Immigrants who begin to use technology while continuing to adhere to their traditional mode of dress are exhibiting what aspect of cultural identity? a. Socialization b. Ethnocentrism c. Assimilation d. Acculturation

ANS: D Acculturation occurs when individuals accept some aspects of a new culture without losing their distinct cultural identity. Assimilation involves a total blending of cultures when individuals actually reject or lose much of their original cultural identity. Ethnocentrism is the belief that one's culture is superior to another. Socialization takes place throughout a person's life and involves nurture and a gradual acquisition of cultural characteristics.

8. What intervention should be initiated first by a nurse assigned to care for a culturally diverse patient admitted with significant body odor? a. Approach the patient with washcloths and towels ready to give a bath. b. Contact family members or friends to learn more about the situation. c. Ask the patient to bathe prior to conducting an admission assessment. d. Seek information to determine the underlying cause of the body odor.

ANS: D Assessment of the underlying cause of the body odor is the first step to patient-centered care. Assisting the patient to bathe or asking the patient to bathe may be appropriate interventions once the underlying cause of the body odor is established. Asking family or friends for insight into the source of body odor would be a last step if the patient was unable to provide adequate information and a physical assessment did not reveal the cause.

2. A nursing student wants to observe enculturation practices of an ethnic minority community. What action by the student is best? a. Attend a community dance. b. Learn to cook an ethnic meal. c. Visit the group's worship service. d. Observe a grandmother teaching a child.

ANS: D Enculturation is the process of passing a culture down from generation to generation. Culture can be taught directly, for instance, with the grandmother teaching the child. Culture can also be taught indirectly as when a child observes a role in the community. The student observing the grandmother teaching a child is the best example of enculturation.

1. Which action by an individual best demonstrates enculturation? a. Using elaborate symbols to represent words b. Confronting parents with their traditional family values c. Providing for the necessities of life such as food and shelter d. Sharing cultural expectations with younger family members

ANS: D Enculturation is the process of passing culture from one generation to the next. Using symbols is one aspect of culture. Challenging traditional values reflects a developmental stage or change in worldview. Supplying basic needs is not dependent on culture.

9. The nurse is caring for a patient from a culture that is unfamiliar. The patient nodded her head "yes" when asked if she will take her prescriptions as ordered, but the nurse discovers the patient does not take the medication, but uses herbs for treatment. What action by the nurse is best? a. Warn the patient of the consequences on non-compliance. b. Tell the patient how the medication will help the condition. c. Ask the patient why herbal preparations are preferred. d. Ask the patient to explain the meaning of the herbal products.

ANS: D Ethnocentrism is the belief that one's cultural beliefs are superior to others. In order to avoid practicing in an ethnocentric manner, the nurse needs to understand the meaning of the herbal preparation to the patient. Warning the patient of bad outcomes will not achieve the desired results if the herbs are culturally important and meaningful to her. Patient education is always important but is not the best answer because it does not allow the nurse to learn from the patient. Asking "why" questions is a communication barrier likely to put the patient on the defensive.

18. A student nurse is caring for a patient who is a refugee. The patient will take his own blood glucose readings and will self-administer a set dose of insulin but will not follow a sliding scale regimen in which the patient has to choose what dose of insulin to give. What action by the student nurse is best? a. Ask the provider to prescribe only a set insulin regimen. b. Instruct the patient on the benefits of sliding scale insulin. c. Teach the patient that strict carbohydrate limits are needed. d. Ask the patient to explain the meaning of making this decision.

ANS: D The patient may have a more fatalistic world view than is common in Western societies. The patient may follow "orders" from an authority figure but may feel like it is not his place to determine his insulin dose, or the patient may not feel competent in making that decision. Many explanations are possible. The student needs to determine what the patient feels related to this type of decision making before doing anything else.

What aspect of culture is a full-time employed granddaughter of an elderly Asian female exhibiting if she asks the social worker to place her grandmother in an extended-care facility against the wishes of her parents? a. System change b. Gender role c. Cultural norms d. Shared attributes

Answer: a As one aspect of a society changes, the systems within that society change. The granddaughter in this case is employed full time and unable to adequately care for her grandmother at home. Therefore, her request to have the grandmother placed in an extended-care facility is a reflection of societal changes that affect traditional culture expectations of one generation's providing care in the home. Shared attributes, cultural norms, and gender role all are challenged by the granddaughter's actions.

Culturally competent care would encourage which action by a patient's family? a. Asking the family's spiritual advisor to visit the patient b. Speaking English to everyone involved in patient care c. Adhering to highly publicized restrictive unit visiting hours d. Limiting food consumption to items provided by the cafeteria

Answer: a Culturally competent care allows for flexibility within safety guidelines and patient care limitations. Allowing a patient to meet with a spiritual advisor recognizes the importance of a patient's spiritual needs. Limiting language use, food consumption, and visiting hours in a strict manner without sensitivity to a patient's preference do not reflect culturally competent nursing care.

If a patient's primary language differs from that of the health care professionals providing care, which action is most appropriate for the nurse to take? a. Use colorful pictures, white boards, and gestures to communicate all important information. b. Recognize that continuous affirmative answers by the patient require verification of understanding. c. Arrange for a professional language translator to sit with the patient throughout the hospitalization. d. Decrease interaction with the patient and family to avoid making them uncomfortable for not understanding.

Answer: b Consistent affirmative answers from a patient in the form of verbal responses of nods may indicate that a patient does not really understand what is being asked and is just trying to be cooperative. It is important for the nurse to double check to make sure a patient understands instructions and questions to ensure safety and proper care. Not all information can be conveyed via pictures or gestures, and professional interpreters typically are not used as patient sitters. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.

How best can a nurse evaluate goal attainment for a patient with a culturally diverse background? a. Assume that gender roles will be a challenge to overcome regardless of the patient's ethnicity. b. Base decisions on feedback from the patient and the nurse's professional judgment. c. Collaborate with future community care providers to determine patient strengths. d. Seek input from members of the patient's support system to avoid biased patient responses.

Answer: b Decisions about whether a patient has met treatment goals or outcomes should be based on patient feedback and a nurse's professional judgment. Gender role considerations are unlikely to play a role in evaluation. Future community care providers are unable to help in the evaluation of patient goals before participating in a patient's care. The patient is the primary person from whom information should be obtained in evaluating goals and outcomes.

Which action taken by a nurse would reflect application of an appropriate generalization in a patient care setting? a. Assigning same-gender nurses to all patients admitted to the unit b. Sharing with unlicensed assistive personnel that typically Muslim patients do not eat pork c. Telling the radiology technician that every Latino family is late for appointments d. Assuming that Asians share financial responsibility for medical bills

Answer: b Muslims typically do not consume pork products. This generalization would be helpful to use as a baseline for caring for Muslim patients. It is always important, however, for nurses to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements that are unkind regarding people of one culture is stereotyping and hurtful. The Amish, not Asians, typically share responsibility for medical bills.

Which nursing diagnosis is most appropriate for a young Middle Eastern immigrant who expresses concern for the safety of his family members who were unable to relocate with him out of a war zone? a. Risk for Spiritual Distress b. Impaired Role Performance c. Interrupted Family Processes d. Ineffective Coping

Answer: c A key-related factor in interruption of family processes is a situational crisis that causes a change in communication and emotional and mutual support, which all are present in this case. None of the information provided indicates a spiritual crisis, ineffectiveness of coping, or impairment of role performance.

Which statement best serves as a guide for nurses seeking to learn more about ethnicity? a. Ethnicity, like culture, generally is based on genetics. b. A patient's ethnic background is determined by skin color. c. Ethnicity is based on cultural similarities and differences in a society. d. Culture and socialization are unrelated to the concept of ethnic origin.

Answer: c Ethnicity is based on cultural similarities and differences in a society or nation. The similarities are with members of the same ethnic group; the differences are between that group and others. Ethnicity is not based on or determined by genetics or skin color. Culture, ethnicity, and socialization are all related concepts.

What is the best method for the nurse to ensure that a Croatian patient's nutritional needs are met during hospitalization? a. Preorder a diet that is consistent with the typical Croatian patient's dietary preferences. b. Ask a Croatian co-worker for ideas on what would be best to order for the patient's meals. c. Request that a variety of dietary entrees be provided to the patient to provide options. d. Check with the patient on admission to determine dietary limitations and preferences.

Answer: d The best way to provide for a patient's dietary needs is to ask the patient for personal preferences, limitations, allergies, and typical dietary intake. Preordering, checking with a co-worker, or ordering a variety of options without input from the patient first does not reflect patient-centered care.

Which of the following questions is/are appropriate to ask during a transcultural assessment? (Select all that apply.) a. How do you act when you are angry? b. What is your role in your extended family? c. Why do you continue to speak German at home? d. When communicating with friends, how close do you stand? e. What is the purpose of not preparing beef with milk products?

Answers: a, b, d How a person acts when angry, the person's role in the family, and comfort with proximity all are relevant aspects of the patient's cultural norms, according to Giger and Davidhizar, and should be assessed to raise the nurse's awareness of patient needs. Asking a patient why they use their native language in the home is unnecessary. If primary language information is needed, the nurse should simply ask what language is spoken in the home. The nurse should not try to seek information about the reason a person maintains dietary traditions during the assessment process.

Which statement(s) reflect/s the practice of transcultural nursing? (Select all that apply.) a. May be considered a general and specialty practice area b. Focuses on the world view rather than patient needs c. Challenges traditional ethnocentric nursing practice d. Aims to identify individual patient care preferences e. Focuses patient care on the nurse's cultural norms

Answers: a, c, d Transcultural nursing is a general and specialty practice that focuses on both world view and individual patient and family needs for planning and providing care. It challenges nurses to investigate other cultures in order to reject ethnocentric care and respond to individual needs.

35. What are the four Cs of culture?

What do you call your problem? What do you think caused your problem? How do you cope with your condition? What are your concerns regarding the conditions recommended treatment?

39. Traditional Western medicine, in contrast to alternative therapy, uses which of the following? a. prescribed medications b. spiritual advising c. acupuncture d. music therapy

a. prescribed medications

36. Indicate which of the following statements are accurate, with consideration that not all individuals from a particular culture will always reflect the belief or practice. Select all the apply. a. Asians generally have a larger body stature than Angelo-americans and Mexicans. b. Orthodox Jewish people require a Kosher diet c. Self-care is valued among most American families d. Amish families tend to share heath care costs e. different-gender caregivers are acceptable for Muslim patients f. Nonverbal communication is important to Japanese individuals

b, c, d, f

41. An older female who is chinese is supposed to have chemotherapy. She is hesitant to agree to this treatment. The nurse who is culturally aware recognizes that this is most likely related to which of the following? a. dependence on health care providers for information b. reliance on family members for decision making c. lack of motivation to participate in self-care d. denial of traditional medical treatment

b. reliance on family members for decision making

25. An individual who is oriented to the present is more likely to exhibit which characteristics or behaivors? Select all that apply. a. look to traditional approaches to health and healing b. delay personal gratification c. believe that time is flexible d. arrive late to scheduled appointments e. maintain a rigid time schedule f. be less likely to practice preventive health care

c, d, f

42. The nurse believes that a patient from another cultural background is using herbal remedies along with the prescribed medication to treat her arthritis. Which of the following should be the nurse's first action? a. tell the patient that herbs will interfere with the prescribed medication b. ask the patient why additional remedies are being used c. determine which herbs are being used and their effectiveness d. contact the physician to alert him or her about the herbal remedies

c. determine which herbs are being used and their effectiveness

40. In working with patients from different cultural background, the nurse may find that the patient and family are not fluent in English. The nurse recognizes which of the following as an appropriate strategy for communicating with patients who are not fluent in English? a. speaking in a louder tone of voice b. responding to the patient by his or her first name c. incorporating pictures and hand gestures d. having a family member act as an interpreter for all communication

c. incorporating pictures and hand gestures

38. Within transcultural nursing, sensitivity to social organization is the recognition of the patient's: a. use of language and gestures b. definition of health and illness c. status and expected role in the family d. psychological characteristicsand coping mechanisms

c. status and expected role in the family

34. The nurse is assessing the patient's time orientation and space needs. Which of the following questions will elicit information in those areas? Select all that apply. a. How often do you have visitors to your home? b. Who or what helps you cope during difficult times? c. How do you define social activities d. If a stranger touches you, how do you react or feel? e. Are you comfortable with the distance between us now f. If the nurse tells you that you will receive a medication in "about half an hour," realistically, how much time will you allow before you call the nurse's station

d, e, f

43. The patient is being prepared for surgery later in the afternoon. The nurse observes that the patient is wearing a religious charm on a chain around her neck. When asked, the patient says that she would like to keep it on. The nurse's best initial approach is to: a. remove the bracelet b. tape the bracelet in place c. ask the patient to remove the item and leave it with family members d. determine if the item may remain in place during the procedure

d. determine if the item may remain in place during the procedure

37. Which of the following is the most important symbol of a culture? a. tools b. beliefs c. clothing d. language

d. language

31. Identify at least three of the areas, according to The Joint Commission, that should be assessed to ensure enhanced communication with culturally diverse individuals.

language preference race ethnicity cultural, spiritual, and religious beliefs

24. How should a nurse assess a dark-skinned person for oxygenation?

least pigmented areas, buccal mucosa, lips, tongue, nail beds, and palms of hands

22. What are the three cultures that the nurse brings into relationships with patients?

the first culture of the personal self the second culture of the health care delivery system the third culture of the patient