NCLEX Culture

2. Provide language assistance to the patient. 3. Ask a nurse who speaks Japanese to take over. Whenever a patient faces language barriers, the nurse should make language assistance available to the patient. This service is free for all patients. A patient may ask a family member to interpret instead of a translator. Nurses who know the patient's language may be asked to take over to help provide better care. Sign language is unreliable for assessment of the patient. Checking the patient physically and starting treatment without communication is inappropriate and can violate patient rights. Learning a new language is a time-consuming process and will not help this patient. Pg. 104, 108

A Japanese patient is admitted to the hospital after a fall. The patient doesn't understand English. Which should the nurse do to promote communication? Select all that apply. 1. Use sign language. 2. Provide language assistance to the patient. 3. Ask a nurse who speaks Japanese to take over. 4. Check the patient physically and start treatment of the disorder. 5. Try to learn Japanese

The step "add" in the C-LARA mnemonic refers to providing the patient and/or the caregivers with additional information that may help them. It may also include educating the patient. The primary health care provider is educating the patient regarding the inclusion of antioxidants and plenty of water in his or her diet. The step "affirm" in the mnemonic means expression of a feeling or a perspective that strengthens the patient's concern. If the primary health care provider responds to a question posed by the patient, then he or she is performing the "respond" step. The "calm down" step is used to relax the patient, wherein the patient is encouraged to stay calm and the pulse rate is determined. Pg. 109

A patient who was cured of cancer is diagnosed with relapse of the disease. The primary health care provider recommends that the patient consume foods rich in antioxidants and drink plenty of water. Which step of the C-LARA mnemonic is the primary health care provider performing? 1. Add 2. Affirm 3. Respond 4. Calm down

2. Assign a female nurse to carry out the examination. Arab women are generally reluctant to have males examine them. The head nurse should respect the patient's wish and culture and assign a female nurse to her. The head nurse should not ask the male nurse to proceed, because this would violate the patient's wish. The mere presence of a female nurse during an examination by a male nurse would not make the patient comfortable. Telling the patient the hospital is short-staffed may not be true and should not be used as an excuse to disobey the patient's wishes. Test-Taking Tip: Look for answers that focus on the patient or are directed toward the patient's feelings. Pg. 103

An Arab woman is admitted to the hospital. A male nurse is assigned to examine this patient. The patient is uncomfortable and expresses displeasure at being assigned a male nurse. What should the nurse manager do? 1. Ask the male nurse to go ahead with the examination. 2. Assign a female nurse to carry out the examination. 3. Remain in the room when the male nurse is examining the patient. 4. Explain to the patient that they are short of staff and that she has to cooperate.

2. Culture Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. These include events such as birth, illness, and dying. Culture refers to the system of meanings by which people make sense of their experiences. Pg. 103, 107

During their clinical postconference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that a patient was homeless. Which difference is being described? 1. Ethnicity 2. Culture 3. Heritage 4. Religion

1. Ask the patient how much salt he is consuming each day. In Asian cultures spoken messages often have little to do with their meanings. The nurse should clarify how much salt the patient is consuming in his diet. Pg. 107

The nurse at an outpatient clinic asks a Chinese American patient with newly diagnosed hypertension if he is limiting sodium intake as directed. The patient nods his head but does not make eye contact with the nurse. What should the nurse do next? 1. Ask the patient how much salt he is consuming each day. 2. Discuss the health implications of sodium and hypertension. 3. Remind the patient that many foods such as soy sauce contain hidden sodium. 4. Suggest some low-sodium dietary alternatives.

3. Allow the patient to pray and come back later to administer the medication. The nurse should respect the patient's religious beliefs. Muslims offer namaz, or prayers, at specific times of the day. The nurse should let the patient complete the prayers and then administer the medication. It would be inappropriate to administer the drugs while the patient is praying because that would show disrespect to the patient. It would be inappropriate for the nurse to ask the patient to delay prayer, because his culture dictates that he pray at specific times. The nurse should not refer to responsibilities with other patients. Test-Taking Tip: Choose answers that reflect culturally competent care. Pg. 104

The nurse has to examine a patient and administer an intravenous medication that is not a life-saving drug. The patient is a devout Muslim. When the nurse goes to administer the medication the nurse finds that patient is getting ready for namaz (prayers). The nurse understands that the patient prays at certain times, as specified in his culture. What should the nurse do in this scenario? 1. Administer the drug while the patient prays. 2. Ask the patient to pray after the medication is administered. 3. Allow the patient to pray and come back later to administer the medication. 4. Tell the patient that the nurse has other patients to look after and cannot come later.

2. Establish trusting relations with the patient. 3. Obtain information by asking open-ended questions. 4. Gather area demographic information from census data. Cultural assessment is time-consuming and establishing trusting relations with the patient is helpful. Using open-ended and focused questions can encourage patients to provide information about their cultural values. Gathering background demographic knowledge of the patient's culture can help in cultural assessment. Understanding patients' beliefs about health care is an important part of cultural assessment. Obtaining information about economic backgrounds is not relevant to cultural assessment. Pg. 107

The nurse is assessing patients from different cultural backgrounds. Which actions should the nurse perform to obtain a systematic cultural assessment? Select all that apply. 1. Overlook the patient's beliefs about health care. 2. Establish trusting relations with the patient. 3. Obtain information by asking open-ended questions. 4. Gather area demographic information from census data. 5. Obtain information about economic backgrounds.

1. Negotiate for a change in the patient's cultural practices. 2. Preserve the patient's values relevant to maintaining his health. 4. Modify the patient's lifestyle to develop a beneficial health care pattern. The nurse may be able to negotiate a change in the patient's cultural practices to promote a desirable health outcome. The plan should preserve the patient's cultural values but still modify his lifestyle. This would help him reduce the conflicts between his health care needs and his practices. A standard care plan does not address cultural differences among patients. Insisting that the patient change all of his cultural practices likewise does not help the patient to honor his culture while improving his health. STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment. Pg. 104, 108

The nurse is caring for a 50-year-old Hindu Asian male patient who is hospitalized following an incidence of high blood pressure. The nurse reviews the data and concludes that the patient's health care needs conflict with his health care practices. His cultural practices do not help him to maintain normal blood pressure and manage his diabetes. How should the nurse implement culturally congruent care? Select all that apply. 1. Negotiate for a change in the patient's cultural practices. 2. Preserve the patient's values relevant to maintaining his health. 3. Develop a standard care plan applicable for every patient. 4. Modify the patient's lifestyle to develop a beneficial health care pattern. 5. Explain to the patient that his cultural practices are unhealthy and need to change.

Koreans believe that seaweed soup should be given to a woman immediately postpartum because it cleans the blood and helps healing and lactation. Tomato, sweet corn, and hot garlic soups can be given later but are not specifically part of the Korean culture. Pg. 106

The nurse is caring for a Korean woman who has just delivered her first baby. Which soup should the nurse anticipate the family to provide as the first meal to the woman? 1. Tomato soup 2. Sweet corn soup 3. Seaweed soup 4. Hot garlic sou

1. Reschedule meals. 4. Respect the cultural beliefs and assure the patient that medical needs will be taken care of. The nurse should understand the patient's cultural and spiritual beliefs and deliver health care accordingly. Muslims fast during Ramadan. Therefore, the nurse should not assume that the patient will take regular meals during Ramadan. Likewise, the treatment and medication regimen should be rescheduled according to the cultural needs of the patient. The nurse should respect the patient's culture and assure the patient that the hospital staff will provide optimal care. Asking the patient's family to ask the patient not to fast would be emotionally disturbing. Starting enteral tube feedings is also not ethical, because they would be against the patient's will. Trying to convince the patient to have meals may indicate that the nurse disrespects the patient's personal beliefs. Pg. 103

The nurse is caring for an Islamic patient who is recovering from a motor vehicle accident. The patient is observing Ramadan, the ninth lunar month, in which Muslims fast during daylight for 28 days. The nurse understands that a good diet is important for the patient's wounds to heal. What should the nurse do when planning the patient's diet? Select all that apply. 1. Reschedule meals. 2. Ask the patient's closest kin to ask him not to fast. 3. Start enteral tube feedings if the patient refuses to take food orally. 4. Respect the cultural beliefs and assure the patient that medical needs will be taken care of. 5. Try to convince the patient not to fast, because it will affect recovery.

2. "What do you think caused your illness?" 3. "How do you want us to help you with your problem?" An open-ended question is asked to encourage the patient to provide expansive responses. Asking what the patient thinks caused the illness and how the patient wants the health care team to help him or her are examples of open-ended questions. Asking whether the patient has had the problem before is an example of a focus question. Inquiring about the difference between the present and the previous problem is a contrast question. Asking whether the patient would like the nurse to discuss the required care with a guardian indicates caring beliefs and practices but is not an example of an open-ended question. Pg. 107

The nurse is conducting a health interview for a patient. Which assessment question is an example of an open-ended question? Select all that apply. 1. "Did you have this problem before?" 2. "What do you think caused your illness?" 3. "How do you want us to help you with your problem?" 4. "How different is this problem from the one you had previously?" 5. "Is there someone with whom you want us to talk about your care?"

2. It will help the nurse to interpret the needs of the patient who belongs to a different culture. 3. It will help the nurse to identify the similarities and differences of various patients across different cultures. 4. It will help the nurse to deliver the specific kind of health care that is expected from patients who belong to a different culture. Culturally congruent nursing refers to a comparative study of cultures to understand similarities and differences across human groups. It helps the nurse to identify the needs of a patient who belongs to a different culture. Culturally congruent nursing can help the nurse to identify the similarities and differences in various patients across different cultures. It also helps the nurse to meet the health care expectations of patients who belong to different cultures. Culturally congruent nursing does not help the nurse to interact with people in different languages. The nurse does not deliver remedies common in different cultures. Pg. 103

The nurse is learning about the impact of different cultures on nursing. Which are benefits of culturally congruent care? Select all that apply. 1. It will help the nurse to interact with different people in their language. 2. It will help the nurse to interpret the needs of the patient who belongs to a different culture. 3. It will help the nurse to identify the similarities and differences of various patients across different cultures. 4. It will help the nurse to deliver the specific kind of health care that is expected from patients who belong to a different culture. 5. It will help the nurse to deliver different remedies for an illness as practiced in the patient's culture.

4. "Is there someone with whom you want us to talk about your care?" Asking the patient if there is someone with whom he or she would like the health care team to discuss his or her care is an example of a focused question. Asking the patient what he or she does to keep him- or herself well assesses the patient's beliefs and practices. Asking the patient with whom he or she lives assesses the patient's social organization. Asking the patient what he or she thinks the reason is for an illness is an open-ended question. Pg. 107

The nurse is performing a cultural assessment of a patient. Which question of the nurse reflects a focused question? 1. "Who lives with you?" 2. "What do you do to keep yourself well?" 3. "What do you think caused your illness?" 4. "Is there someone with whom you want us to talk about your care?"

4. "Please review what we talked about. How will you make it work at home?" The "Teach Back" technique helps the nurse confirm whether the patient has understood the teaching or not. When using the teach-back technique, the nurse should ask open-ended questions such as asking the patient to review the information and explain how he or she will make it work at home. This question will help the nurse to verify the patient's understanding. The nurse should not ask the patient whether he or she understood the teaching, whether he or she has any questions, or about the usefulness of the provided information, because these are unlikely to elicit detailed answers that reflect the patient's understanding. Pg. 100, 111

The nurse is using the "Teach Back" technique to evaluate a patient after teaching about medication adherence. Which question by the nurse is appropriate to verify the patient's understanding? 1. "Did you understand?" 2. "Do you have any questions?" 3. "Please let me know whether this information was useful to you." 4. "Please review what we talked about. How will you make it work at home?"

3. Cultural encounter Campinha-Bacote's model of cultural competency includes interrelated components. Cultural encounter involves the cross-cultural interactions between the nurse and the patient that provide opportunities to learn about other cultures and develop effective intercultural communication. Cultural skill is the ability to assess the social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire is the motivation and commitment to care for a patient. Cultural knowledge is the knowledge of diverse groups, including the values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group. Pg. 104, 105

The nurse, while caring for a patient of a different cultural background, learns about their cultural practices that affect health. The nurse uses these facts to plan the patient's care for better acceptance. Which component of Campinha-Bacote's model of cultural competency is reflected in this scenario? 1. Cultural skill 2. Cultural desire 3. Cultural encounter 4. Cultural knowledge

1. "Cultural assessment models are used to stereotype a particular group of patients." Stereotyping is generalizing a patient based on his or her cultural group. Cultural assessment models are used to understand the cultural beliefs of a patient and are not used to generalize (stereotype) the patient. Cultural assessment models help to focus on the information relevant to patient's problem by providing a worldview. Cultural assessment models are used to understand patient's religious beliefs and the complex factors that influence a patient's cultural worldview. Pg. 107

The registered nurse is evaluating the statements of a student nurse after teaching about cultural assessment models. Which statement by the student nurse needs correction? 1. "Cultural assessment models are used to stereotype a particular group of patients." 2. "Cultural assessment models help to focus on the information relevant to patient's problem." 3. "Cultural assessment models can be used to understand a patient's religious beliefs." 4. "Cultural assessment models help one to understand the complex factors that influence a patient's cultural world view."

1. "I should avoid using models during the teaching process." 3. "I should ask the patient whether he or she understood the teaching." The nurses can use different methods to explain a concept or procedure to a patient until he or she feels confident that the patient has understood. The use of models is one such method the nurse can employ. The nurse should not ask whether the patient has understood but should instead check the patient's extent of learning or verify understanding by asking the patient specific questions about the teaching. The nurse can use charts/pictures to facilitate better understanding. The Teach-Back technique is an ongoing process of asking patients for feedback through explanation. Therefore, patients can be permitted to ask questions during the course of teaching. In case the patient doesn't understand completely, the nurse should explain it to the patient again after the first round of teaching. Pg. 100

The registered nurse is evaluating the student nurse for the Teach-Back technique. Which statements made by the student nurse indicate the need for further teaching? Select all that apply. 1. "I should avoid using models during the teaching process." 2. "I should use charts to facilitate patient understanding." 3. "I should ask the patient whether he or she understood the teaching." 4. "I should let the patient ask questions during the course of teaching." 5. "I should teach the patient again after finishing the first round of teaching."

4. Background, personal biases, and prejudices Cultural awareness involves an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people. Pg. 104

To enhance cultural awareness, which should the nursing students include in their self-examination? 1. Motivation, culture, and commitment to caring 2. Social, cultural, and biophysical factors 3. Engagement in cross-cultural interactions 4. Background, personal biases, and prejudices

1. To provide care to fit with a patient's own values, beliefs, and traditions. The goal of transcultural nursing is to provide care to fit with the patient's own values, beliefs, and traditions. Cultural awareness is required to recognize biases, prejudices, and assumptions about other people. Cultural skill helps to assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire involves the motivation to learn from others, accept the role as a learner, and be open to and accepting of cultural differences. Pg. 103

What is the goal of transcultural nursing? 1. To provide care to fit with a patient's own values, beliefs, and traditions 2. To help with recognizing biases, prejudices, and assumptions about other people 3. To assess social, cultural, and biophysical factors that influence patient treatment and care 4. To motivate the nurse to learn from the others, accept the role as a learner, and be open to and accepting of cultural differences

. "Do you use any folk remedies?" 2. "Do you have a family physician?" 3. "Do you use a Shaman?" The nurse should obtain information about folk remedies and cultural healers that the patient uses. Assessment data yield information about the patient's beliefs about the illness and the meaning of the signs and symptoms. Pg. 107

When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? Select all that apply. 1. "Do you use any folk remedies?" 2. "Do you have a family physician?" 3. "Do you use a Shaman?" 4. "Does your family have a history of alcohol abuse?" 5. "Do you have medical insurance to cover your emergency room admission?"

1. Discrimination Prejudices associate negative characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs. Prejudices are not compatible with culturally congruent care, effective intercultural communication, or sufficient knowledge of diverse groups. Pg. 104

When the nurse has a prejudice against a particular culture, which type of behavior is likely to result? 1. Discrimination 2. Culturally congruent care 3. Effective intercultural communication 4. Sufficient knowledge of diverse groups

3. Social inequality Social inequality is the concept of intersectionality that involves groups with unequal access to resources, services, and positions. Overinclusion addresses groups that have been overlooked in research and the design of interventions. Marginalization the concept of intersectionality that provides limited access or exclusion from different facets of the society such as a political system, labor market, or positions of power. Matrix of domination is a concept of intersectionality that involves the groups with a larger system of power and more privileges than other groups in the society. Pg. 103

Which concept of intersectionality involves unequal access to resources and services? 1. Overinclusion 2. Marginalization 3. Social inequality 4. Matrix of domination

4. "How severe is your headache compared to the last one?" The questions pertaining to comparison of two events are called contrast questions. The question, "How severe is your headache compared to the last one?" compares pain occurring at two different times. "Do you have siblings?", "Where does it hurt more often?", and "How long have you been alone?" are examples of open-ended questions. Pg. 107

Which is an example of a contrast question? 1. "Do you have siblings?" 2. "What area hurts most often?" 3. "How long have you been alone?" 4. "How severe is your headache compared to the last one?"

2. Make sure that they have access to unisex bathrooms 3. Ensure that gender-inclusive language is used while talking 5. Ensure that gender-inclusive information is asked in the hospital forms Patients belonging to the LGBT community may differ in appearance from the conventional male and female appearance and may feel uncomfortable using gender-specific restrooms. Therefore health care organizations should ensure that patients belonging to the LGBT community have access to unisex restrooms. Health care professionals should use neutral language while talking to patients, such as partner or significant other rather than husband or wife, because LGBT patients may also be married. All the forms used in the hospital should have an LGBT query section to facilitate disclosure. Health care organizations should not encourage identification of patients on the basis of their physical appearance, because the assumptions may be wrong. Health care organizations should ensure that patients are asked about gender, because presumptions may cause errors in treatment. Test-Taking Tip: The patients belonging to LGBT community may have an altered appearance and a conservative attitude. Answer the above question by keeping these tips in mind. Pg. 105

Which measures taken by the health care organizations would create an inclusive environment for patients belonging to the lesbian, gay, bisexual, transgender (LGBT) community? Select all that apply. 1. Identify on the basis of their appearance 2. Make sure that they have access to unisex bathrooms 3. Ensure that gender-inclusive language is used while talking 4. Avoid enquiring about their gender to avoid discomfort 5. Ensure that gender-inclusive information is asked in the hospital forms

3. "What do you do to keep yourself well?" Asking the patient about what he or she does to keep well indicates that the nurse is assessing the beliefs and practices of the patient. Asking the patient what caused the problem indicates assessment of bicultural ecology. Questioning the patient about the main source of income indicates assessment of socioeconomic status. Asking the patient how to address him or her indicates that the nurse is assessing language and communication. Pg. 107

Which question does the nurse ask a patient to assess the beliefs and practices of the patient? 1. "What caused your problem?" 2. "What is your main source of income?" 3. "What do you do to keep yourself well?" 4. "How should we address you or what should we call you?"

3. Assessing social, cultural, and biophysical factors before initiating the treatment Campinha-Bacote's model suggests that nurses see themselves as becoming rather than being culturally competent because cultural competency is developmental. Cultural skill is better explained by the ability to assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural awareness involves an in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people. Cultural encounters provide cross-cultural interactions that create opportunities to learn about other cultures and develop effective intercultural communication. Cultural knowledge helps the nurse obtain sufficient comparative knowledge of values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group. Pg. 105

Which statement describes cultural skill according to Campinha-Bacote's model of cultural competency? 1. Examining oneself in-depth and recognizing the bias 2. Providing opportunities to learn about different cultures 3. Assessing social, cultural, and biophysical factors before initiating the treatment 4. Obtaining the knowledge about values, health beliefs, and care practices of various cultures

4. Culturally congruent care sometimes diverges from the values of the professional health care system. Culturally congruent care sometimes diverges from the values and meanings of the professional health care system. Patterns of life and systems of meaning are generated by people themselves. Culturally congruent care bridges gaps to provide supportive care for all patients, not only patients from certain cultures. Transcultural nursing provides culturally congruent care, or care that fits a person's life patterns, values, and the system of meaning. Pg. 103

Which statement is true regarding culturally congruent care? 1. Culturally congruent care has predetermined criteria from which patterns of life and the system of meaning are generated. 2. Culturally congruent care bridges gaps to provide supportive care for patients from certain cultures. 3. In culturally congruent care, transcultural nursing enables primary health care providers to deliver uniform services irrespective of health beliefs. 4. Culturally congruent care sometimes diverges from the values of the professional health care system.

2. They help reduce mortality, complications, and inpatient readmissions. Core measures help to reduce mortality, complications, and inpatient readmissions. Cultural awareness helps the nurse to recognize prejudices and assumptions about other people. Culturally congruent care helps to provide care that fits with patients' own values, beliefs, and traditions. Cultural skills help to assess social, cultural, and biophysical factors that influence patient treatment and care. Pg. 111

Which statement is true regarding the goal of core measures? 1. They help recognize prejudices and assumptions about other people. 2. They help reduce mortality, complications, and inpatient readmissions. 3. They help provide care that fits with the patient's own values, beliefs, and traditions. 4. They help assess social, cultural, and biophysical factors that influence patient treatment and care.

2. Biomedical Most Western cultures believe that illnesses have biomedical causes. Beliefs that illnesses are caused by supernatural or medicoreligious causes, or by an imbalance between humans and nature, are more common in non-Western cultures. Pg. 106

Which term best describes the type of elements that people in Western cultures believe cause illness? 1. Supernatural 2. Biomedical 3. Medicoreligious 4. Imbalance between humans and nature

1. Rapport Seeking the patient's point of view during the assessment indicates an effort to build rapport. Asking and trying to understand the barriers to care and adherence indicates an effort to provide support. Verbally acknowledging and legitimizing the patient's feelings indicates empathy. Using verbal clarification techniques indicates the use of explanations as they apply to the RESPECT mnemonic. Pg. 109

While assessing a patient with a psychiatric disorder, the nurse seeks the patient's point of view. Which process of the RESPECT mnemonic is the nurse employing? 1. Rapport 2. Support 3. Empathy 4. Explanations