Chapter 7

You are a community health nurse who provides care to a group of Hispanic people living in an area that is predominantly populated by Caucasian people. How would you characterize the Hispanic people in this community?

A minority

A hospitals written policies and procedures are being reviewed as part of an accreditation process. Which of the following policies are congruent with the principles of culturally competent nursing care? Mark all that apply.

A policy that outlines the appropriate use of translation services A policy guiding staff in the care of patients with different values A policy that establishes flexible regulations pertaining to visitors

Personal space and distance is culturally dependent and can impact nursepatient interactions significantly. What is the best way for the nurse to interact with a patient who has a different cultural perspective on space and distance?

Allow the patient to adopt a position that is comfortable for him or her.

An emergency department nurse is preparing to inspect and palpate the head and scalp of an older adult who experienced a fall. A member of which group would most likely consider this examination as a violation of norms?

Asian American

The nurse is providing care for an older adult patient who has a diagnosis of shingles. The nurse is aware that this health problem is attributable to the varicella zoster virus. This belief is an example of which paradigm explaining the cause of disease and illness?

Biomedical

You are performing a cultural nursing assessment of a newly admitted patient of Cuban descent. What would you include in your assessment? Select all that apply.

Family structure Cultural beliefs Health practices Values

In a small, rural hospital the nurse is caring for a patient who speaks a language other than English. The nurse needs to use an interpreter to communicate but the hospital does not have access to an interpreter who speaks the patients language. When choosing another individual to interpret for this patient, what characteristic should the nurse prioritize?

Interpreter should be fluent in several dialects of the patients language.

The nurse is helping a patient choose her menu options for the following day. The nurse reads out the option of ham with scalloped potatoes and the patient states that her religion does not allow this. Which of the following is most likely the patients religion?

Islam

Most nurses have been taught to maintain direct eye contact when communicating with patients. However, some cultural groups do not usually value direct eye contact when communicating with the nurse. Which cultural group would most likely consider the direct eye contact impolite?

Native Americans

You are planning an educational inservice for your nursing colleagues with the goal of fostering culturally competent care. What outcome should you prioritize when planning this education?

Participants will acknowledge and adapt to diversity among their colleagues.

You are the nurse caring for a patient who is a recent immigrant to the United States from Mexico. Which of the following variables would you prioritize when performing an assessment of the patients cultural beliefs?

Patients communication style

The nurse assessing health disparities in the community is focusing on disparities that exist apart from those between ethnic groups. In which of the following groups are these disparities most evident?

People with disabilities

Computed tomography of a 72-year-old woman reveals lung cancer with metastasis to the liver. The patients son has been adamant that any bad news be withheld from his in order to protect her from stress, stating that this is a priority in his culture. How should the nurse and the other members of the care team best respond?

Speak with the son to explore his rationale and attempt to reach a consensus.

A 56-year-old woman who emigrated from Vietnam as an adult was admitted with a urinary tract infection, but has now developed urosepsis. The nurse is in the process of changing the patients plan of care accordingly. The nurse should consider what phenomenon that tends to occur in patients of all ages when they are ill?

Tendency to regress in language skills

During an orientation class, the medical units nursing educator is presenting education on transcultural nursing to a group of new nursing graduates. What should the staff educator identify as the underlying focus of transcultural nursing?

The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care.

A nurse is planning the care of a 48-year-old woman who has just received a diagnosis of breast cancer. The patient has been explicit about her desire to integrate a variety of complementary therapies into her treatment regimen. What is the nurses primary responsibility around the use of complementary therapies?

To assess the patients use of complementary therapies in order to promote safety

The nurse is preparing a discharge teaching session with an Asian patient to evaluate the patients ability to change a dressing. The patient speaks and understands minimal English. What would be the best way to promote understanding during the teaching session?

Use an interpreter during the teaching session.

An infant with a diagnosis of pyelonephritis is receiving care on the pediatric unit and the nurses review of the childs electronic health record reveals that the infant has not received any of her scheduled immunizations. The mother informs the nurse that immunizations are against her cultural beliefs, and she does not want her child to receive immunizations. In this scenario, what do the mothers views on immunizations represent?

A cultural taboo

Prior to planning health promotion interventions in your local community, you are appraising the key health care indicators in your region and comparing them with those in the nation as a whole. What do these key indicators reveal about the United States?

A significant gap in health status between the overall population and people of specific ethnic backgrounds

In planning the nursing care of a patient who lives with chronic pain, the nurse has included the intervention of therapeutic touch. When categorizing this particular complementary therapy, the nurse should identify it as which of the following?

An energy therapy

A nurse who provides care on a busy medical unit is aware that his own beliefs do not always coincide with the beliefs of patients from some cultural backgrounds. What aspects of patient care may be most influenced by diverse cultural perspectives?

Obtaining informed consent

After working with a patient who has human immunodeficiency (HIV) for several weeks, the nurse has become more aware of the role of health disparities. Which of the following variables are known to underlie health disparities? Select all that apply.

Poverty Isolated geographic location Overdependence on publicly funded facilities

A nurse is providing care for a female patient who is Hispanic. The care team is discussing the patients nutritional status and one of the nurses colleagues states, I suppose we should try to get her some tacos or burritos since thats what shes probably used to. How should the nurse best interpret the colleagues statement?

The colleague may have stereotypical views of Hispanics.

You are caring for a patient who is terminally ill whose family has requested to hold a spiritual ceremony during which they will be using incense. What would be the best intervention you could make on behalf of this patient?

Arrange for the ceremony to occur after notifying all departments affected.

A 54-year-old African American man has presented for a follow-up appointment shortly after being diagnosed with hypertension and being placed on an angiotensin-converting enzyme (ACE) inhibitor. The nurse takes the patients vital signs at the beginning of the appointment and obtains a blood pressure of 177/96 mm Hg. What factor should the nurse consider in light of the patients sustained high blood pressure?

Biologic variations may be influencing the effectiveness of the medication.

The future of transcultural nursing care lies in finding ways to promote cultural competence in nursing students. How can this goal be best accomplished?

By offering multicultural health studies in nursing curricula

You are admitting a patient who is a recent immigrant from China and who has a diagnosis of adenocarcinoma. During the patients admission assessment, the patient speaks of her beliefs related to health care and indirectly references the yin/yang theory. Based on her cancer diagnosis and her yin/yang beliefs, which meal will the patient most likely order for lunch?

Chicken noodle soup with crackers, fruit crisp, and hot tea

Agency policies are important to achieve culturally competent care. When reviewing a hospitals current policy framework, which of the following actions has the potential to improve the overall level of culture competence?

Creating greater flexibility in visiting hours

A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects.The nurses behavior is an example of what?

Cultural imposition

A nurse is caring for a child with a diagnosis of hemophilia. The child is in need of a blood transfusion, which her familys religious beliefs forbid. What term would best describe this religions beliefs and their impact on health care for this child?

Cultural taboo

A nurse is auditing the care of a recently discharged patient and is appraising the patients care in light of Leiningers theory of Culture Care Diversity and Universality. Specifically, the nurse is looking for evidence that caregivers implemented professional actions and decisions that helped the patient achieve a beneficial or satisfying health outcome. What aspect of Leiningers theory is the nurse addressing?

Culture care restructuring

A nurse is caring for an elderly woman who predominantly identifies with an East Asian culture. How can the nurse best demonstrate an awareness of culturally congruent care?

Establish effective communication.

Giger and Davidhizar (2012) created an assessment model to guide nurses in exploring cultural phenomena that might affect nursing care. When using this model in the care of a patient who has had a transurethral prostate resection (TUPR), what area of care would be influenced most directly?

Explaining the rationale for continuous bladder irrigation (CBI)

A nurse has been having a number of challenging nursepatient interactions when providing care for a patient whose surgery was complicated by a medical error. When interacting with patients and families, of what must the nurse be cognizant?

Her own cultural orientation

In your role as a community health nurse, you are focusing your current health promotion efforts on diseases that are disproportionately represented among ethnic and racial minorities. Which of the following diseases would you likely address? Select all that apply.

Human immunodeficiency virus (HIV) Cancer Heart disease

The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes to the unit. During the initial assessment, the patient informs the nurse that he has been seeking assistance and care from the shaman in his community. The nurse recognizes that the patients blood pressure and his blood sugar level are elevated upon admission. What is the nurses best response to the patients indication that his care provider is a shaman?

I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may lower your blood pressure and blood sugar levels.

Touch, to a great degree, is culturally determined. When providing care for a patient who belongs to a Hispanic culture, which of the following may be considered inappropriate in a health care setting?

Males participating in health care activities.

A nurse provides care in an inner-city hospital that serves a culturally diverse population. When attempting to foster positive and therapeutic nursepatient interactions, the nurse should recognize that these interactions are primarily dependent on what variable?

The ability to understand and be understood

A nurse is describing and demonstrating the technique for emptying a Vietnamese patients surgical drain, knowing that the patient will soon be discharged home with the drain in place. As the nurse is explaining, the patient laughs at times that appear unrelated to what the nurse is saying or doing. How should the nurse best understand the patients behavior?

The patient may be unable to fully comprehend the information the nurse is trying to convey.

The quality improvement team at a large, urban hospital has recognized the need to better integrate the principles of transcultural nursing into patient care. When explaining the concept of transcultural nursing to uninitiated nurses, how should the team members describe it?

Transcultural nursing refers to research-focused practice that focuses on patient-centered, culturally, competent nursing.