TCN Week 4: Chapter 4
Which response is most appropriate when a client describes the alternative medicine therapy he has been using to treat his "stomach problems"? "Who suggested this particular treatment to you?" "Most alternate medicine therapies hadn't been researched for either safety or effectiveness." "Share why you are more willing to use alternative medicines than those that have been proven effective?" "Have you been seen by a physician for these symptoms?"
"Most alternate medicine therapies hadn't been researched for either safety or effectiveness." *Rationale: While some scientific evidence exists to support the safety and efficacy of selected CAM therapies, there needs to be a great deal more research on most of these therapies before their safety and efficacy can be documented for treating the diseases or medical conditions for which they are used. The remaining options could be taken as being argumentative. P. 115, Efficacy of Complementary Health Approaches
When applying Mechanic's model of illness behavior, which assessment question best supports the nurse's attempt to determine the client's motivation for seeking health care? "Do you know what happened to cause the pain in your shoulder?" "What have you been doing to help minimize the pain in your shoulder?" "How long have you been experiencing this pain in your shoulder?" "Has your ability to go to work been affected by the pain in your shoulder?"
"Has your ability to go to work been affected by the pain in your shoulder?" *Rationale: Mechanic's model of illness behavior has proposed 10 determinants of illness behavior that are important in the help-seeking process. Knowledge of these factors can help the nurse appreciate the client's behaviors and decisions about seeking and complying with health care. Situations that are disruptive in work or other social situations are likely to be labeled as illness much sooner than the same behaviors in a family setting. The other options are focused on assessing the pain itself. P. 108, Table 4-1: Mechanic's Determinants of Illness Behavior
The nurse is aware that some clients will not recognize the seriousness of their illness. Which statement by the client might reflect that they are not perceiving the seriousness of the symptoms that are being seen? "I hope I can get some more sleep tonight. I always feel so tired." "I can't believe I hit my finger again." "As soon as I can afford a day off, I'll go to the doctor, I promise." "These new glasses are working great. I can see again."
"I hope I can get some more sleep tonight. I always feel so tired." *Rationale: Once a symptom is perceived, the symptom must then be interpreted. Often people will explain the symptom within normal parameters because either they don't recognize the seriousness of the situation or their current life situation is presenting barriers to appropriate health care so they are explaining away their symptoms. Fatigue is a common symptom in a variety of disorders, but it is also common to assign a different meaning to what is happening. Waiting to see the physician when one has the time might indicate a lack of motivation or a barrier to treatment. Hitting oneself and correcting a problem would not be considered part of Mechanic's Determinants of Illness Behavior. P. 108, Table 4-1: Mechanic's Determinants of Illness Behavior
Which statement best exhibits a belief in a magico-religious health belief system? "My child is so sick because God is punishing me." "My family will be visiting after Sunday church service." "My family has been members of our church for four generations." "My church has placed me on our prayer list."
"My child is so sick because God is punishing me." Rationale:In the magico-religious paradigm, it can be believed that one person's actions may directly or indirectly influence the health or illness of another person resulting in the belief that illness is a result of inappropriate behavior by someone other than the client. The remaining options express the client's connect to religion but not the belief that religion plays a role in physical illness. P. 104, Magico-Religious Health Paradigm
Which statement demonstrates the nurse's understanding of the importance cultural symbolism has on nursing care? "Would you like me to close your room's door when you are praying?" "Do you use a folk remedy for your skin problem?" "Will you explain to me what you mean when you say your heart hurts?" "Will your son be here when we discuss your medications?"
"Will you explain to me what you mean when you say your heart hurts?" *Rationale: Nurses often take for granted that all their clients define and relate to these health concepts in the same way they do. Such an assumption accounts for many of the problems nurses face when they try to communicate with others who are not members of the health profession culture. The remaining options are not directed at clarification of a client's perception but rather providing care. P. 103, Cultural Belief Systems
A home health care nurse is visiting a new client and notices a few bottles of supplements that are not recorded in the care plan. What is the bestapproach for this nurse to take? "You know you shouldn't be taking any supplements without your physician's knowledge, right?" "Who told you to take these supplements?" "Does your physician know you are taking these supplements?" "Would you mind telling me if these supplements are yours?"
"Would you mind telling me if these supplements are yours?" *Rationale: Research has been conducted on some supplements and the interactions of common ones with various other medications is known. The nurse should first inquire if the client is the one taking them and then educate the client concerning possible interactions and/or contraindications with any prescribed medications that they might be currently taking. The nurse should document and encourage the client to discuss this with their physician. To inform the client not to take them is ignoring the cultural aspect and knowing who recommended them is not the top priority. P. 109, Box 4-1: Tips for Making Informed Decisions and Evaluating Information about Dietary Supplements
The nurse should be aware many clients are reluctant to disclose they are using alternative methods. Which clients should the nurse be aware may be using alternative methods? (Select all that apply.) A 32-year-old Black female who is 22 weeks' pregnant and this is her first prenatal visit since finding out she was pregnant A 78-year-old White male who is upset his doctor appointment is the same time as his exercise class A 28-year-old Asian male who has not seen a physician in 5 years A 53-year-old Hispanic female who is returning for her first postoperative visit A 24-year-old Aboriginal People female who appears in good condition but has lost 20 pounds since her last visit 1 year ago
-A 32-year-old Black female who is 22 weeks' pregnant and this is her first prenatal visit since finding out she was pregnant -A 78-year-old White male who is upset his doctor appointment is the same time as his exercise class -A 28-year-old Asian male who has not seen a physician in 5 years -A 53-year-old Hispanic female who is returning for her first postoperative visit -A 24-year-old Aboriginal People female who appears in good condition but has lost 20 pounds since her last visit 1 year ago
The nurse is aware that various factors have been identified as influencing an individual's behavior in preventing disease. Which clients represent those factors? (Select all that apply.) The petite grandmother who says, "Every time that commercial comes on, I feel like they are talking about me." The football player who says his coach instructed him to come in for his yearly physical. The 25-year-old female who presents and tells the nurse, "The last time I felt like this, I had a bladder infection." The 54-year-old man who tells the nurse, "My mom made me promise to come for a checkup, but I know I am fine." The boyfriend with a mole whose girlfriend keeps telling him, "That looks just like my uncle's and he had cancer."
-The petite grandmother who says, "Every time that commercial comes on, I feel like they are talking about me." -The 25-year-old female who presents and tells the nurse, "The last time I felt like this, I had a bladder infection." -The boyfriend with a mole whose girlfriend keeps telling him, "That looks just like my uncle's and he had cancer." *Rationale: There are three sets of factors that influence the course of behaviors and practices carried out to maintain health and prevent disease. These can include experience with a given disease condition, cues to action such as media advertisements or advice of a friend. Not all physical assessments are due to specific problems but are conducted to ensure there is an illness or a situation that needs attention. P. 106, Health and Illness Behaviors
The nurse is managing the care of a child newly diagnosed with asthma. Which intervention demonstrates the nurse's application of the holistic health belief system? Determining whether any family member is a cigarette smoker Assessing the child for possible lower respiratory tract infections Educating both child and parents regarding the prescribed medications Evaluating the child's ability to effectively use an inhaler that is prescribed
Determining whether any family member is a cigarette smoker *Rationale: In the holistic paradigm, disease is believed to be the result of multiple environment-host interactions. Asthma is often triggered when a client is exposed to smoke and so treatment would be influenced by knowledge of this environmental factor. The remaining options are examples of the scientific health belief system. P. 105, Holistic Health Paradigm
Which nursing intervention best demonstrates a culturally sensitive approach to a client's belief in the effectiveness of folk healers? Discussing interventions the healer would like incorporated into the client's care plan. Explaining to the client how Western medicine has adopted many folk healing practices. Suggesting that the client be open to the practices of both Western and folk healing. Asking the client to share his or her reasons for having such faith in the healer's abilities.
Discussing interventions the healer would like incorporated into the client's care plan. *Rationale: If clients use folk healers, these healers should be an integral part of the health care team and should be included in as many aspects of the client's care as possible. Engaging in a conversation with the client concerning his or her beliefs is appropriate but does not show the sensitivity the correct option shows. The other options suggest that the client needs to adjust to Western health care practices rather than having his or her practices and beliefs respected. P. 110, Folk Healing System
Which intervention will best assist the nurse in understanding the culturally diverse client's perception and description of his or her current illness? Encouraging the client to describe his or her illness in terms of his or her cultural metaphors Assessing the client's ability to both understand and communicate effectively in English Determining whether the client subscribes to his or her culture's generally held worldview Explaining the meaning of the medical terms that will be used during the assessment process
Encouraging the client to describe his or her illness in terms of his or her cultural metaphors *Rationale: People often use metaphors as a way of thinking about and explaining life's events. In this case, the culturally diverse client may perceive and describe his or her illness in ways that are unfamiliar to the nurse. Explaining the meaning of medical terms and assessing the client's ability to communicate in English will have little effect on how he or she perceives and chooses to describe his or her illness while confirming the client's acceptance or rejection of a cultural worldview will have only limited impact on how the nurse will achieve an accurate understanding of the client. P. 103, Cultural Belief Systems
What knowledge will best assist a nurse in providing nonprejudicial care that is sensitive to the beliefs and practices of a culturally diverse client population? While emotionally important to some clients, cultural beliefs and practices are not major factors regarding their physical health. Clients will define and discuss their needs regarding cultural practices when the nurse encourages them to do so. Culturally congruent nursing care requires the nurse to continuously learn about cultural norms and customs. Nurses will not consciously question the bias of their own thinking and so must make a concerted effort to do so regularly.
Nurses will not consciously question the bias of their own thinking and so must make a concerted effort to do so regularly. *Rationale: Members of a culture share a worldview without necessarily recognizing it. Thinking itself is patterned on or derived from this worldview because the culture imparts a particular set of symbols to be used in thinking. Because these symbols are taken for granted, people do not normally question the cultural bias of their very thoughts. Nurses need to reflect regularly in order to not project biased thinking into their client care. Cultural beliefs and practices can have great impact on the emotional and physical well-being of an individual. The remaining options, while true, do not address the issue of personal bias and its effect on client care. P. 103, Cultural Belief Systems
Which intervention demonstrates integrative nursing care? Including both exercise and calorie control in a client's weight loss plan Educating the client on the importance of limiting his or her intake of both sodium and fat Respecting a client's wish to have his or her minister accompany him or her to the operating room Incorporating both prescription and over-the-counter medications to control pain
Respecting a client's wish to have his or her minister accompany him or her to the operating room *Rationale: In recent years, there has been growing recognition that the positive and negative effects on health brought about by religious and holistic practices can be measured scientifically. When beneficial effects are identified, integrative medicine and nursing incorporates them into client care. The remaining options are examples of combined treatments recognized only by the scientific health belief system. P. 110, Complementary, Integrative, and Alternative Health System
Which scenario would the nurse recognize as denial by a family member? The father who insists the child is just stubborn and misbehaving like he was as a child The wife who has brought in her husband who stopped bathing and going to work The mother who brings in her toddler who doesn't seem interested in playing with other children The son who brings in his father who was found wandering around the neighborhood
The father who insists the child is just stubborn and misbehaving like he was as a child *Rationale: What the father may be dismissing as stubbornness and misbehaving may be an autism spectrum disorder and should be evaluated, so proper treatment can begin. This would be a case of denial of symptom, one of Mechanic's Determinants of Illness Behavior. The other choices show family members who are seeking assistance for their situations. P. 108, Table 4-1: Mechanic's Determinants of Illness Behavior
When providing care that is respectful of a client's health belief system, the nurse bases interventions on the understanding of which of the following? Each health belief worldview incorporates the importance of a health care provider. The major health belief systems do not share mutually accepted principles. The most widely accepted health belief system explains illness in terms of bacteria and viruses. There are three major health belief worldviews that help explain illness.
There are three major health belief worldviews that help explain illness. *Rationale: People embrace three major health belief systems or worldviews: magico-religious, scientific, and holistic, each with its own corresponding system of health beliefs. In two of these worldviews, disease is thought of as an entity separate from self, caused by an agent that is external to the body but capable of "getting in" and causing damage. While the various belief systems may incorporate the role of health care provider, this knowledge has little impact on providing all clients with care that is respectful of their beliefs. The Western worldview of health beliefs is not the most widely accepted view worldwide. P. 103, Health Belief Systems
