Yoost questions for chapters 21 and 22

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

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.)

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

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.)

You are caring for a 28-year-old married man diagnosed with leukemia. He is hospitalized on reverse isolation. It is his anniversary and his wife is planning to visit. What would be appropriate nursing care to promote spiritual health? a. Assist him in planning a celebration of his anniversary. b. Ensure he has adequate pain medication to endure the visit. c. Maintain strict reverse isolation to prevent infection. d. Congratulate the couple on their anniversary.

A (Celebrating their anniversary promotes hope, love, and compassion, while fostering spiritual connections between the husband and wife.)

If you have a Chinese patient, what is an appropriate question to determine religious practices? a. Are there any religious practices I need to know about to help care for you? b. What is your religion? c. Would you like to talk to a chaplain? d. Tell me about your family.

A (Chinese people have diverse religious practices. It is best to inquire what practices affect care. Do not assume a specific religion.)

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.

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.)

You have a male patient who is a follower of Islam. How would this affect your care? a. Integrate prayer times around care. b. Have the wife present during bathing. c. Provide for a kosher diet. d. Maintain the headdress covering.

A (Muslims pray 5 times a day facing Mecca with cleansing preparation (providing a washcloth is appropriate). Modesty is important, which implies that it is best to have a male assistant complete the bath. Muslims do not follow kosher diets or use a headdress.)

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

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.)

What spiritual practices would you incorporate in your care for an American Indian patient from a reservation? a. Storytelling b. Native American foods c. Organic-based medications d. Native American dance and music

A (Storytelling is central to the religion.)

What is the best way to provide spiritual care to a 2-year-old patient? a. Read a childhood story about good vs evil. b. Play hide and go seek and let the child find you every time. c. Let the toddler play with pretend medical supplies. d. Talk to the mother about special religious diets.

A (Toddlers need concrete examples of good vs evil to better understand meaning.)

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.

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.)

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

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.

If you have a patient of Indian heritage who is Hindu, what religious practices would affect nursing care? a. Patient will refuse pain medication because pain is due to bad karma b. Family may bring in hot or cold food and drink from home to help remove toxins c. Patient may have special head coverings that cannot be removed d. Religious leaders are usually involved in health care decision making

B (Hindus integrate both Western and Eastern medicine. They believe that disease is caused by toxins in the body and medicine helps remove toxins. Headdress and gurus are associated with Sikhism.)

1. What is spirituality? a. Practicing religion b. Expressing meaningful aspects of self c. Yoga or other meditative practices d. Spending time with family

B (Spirituality is the expression of meaning and purpose in life. People have different methods of expressing this ... do not assume that any one method is universally helpful.)

You are caring for an 8-year-old who is receiving an intramuscular injection. The patient says, "You hurt me all the time. What did I do wrong?" What is your best response? a. "You didn't do anything wrong." b. "Why do you think you did anything wrong?" c. "Who told you that you did something wrong?" d. "It will only be a little bee-sting."

B (This question encourages the child to think about case and effect. . Spiritual care differs according to the patient's developmental age. For the school age child, spiritual growth happens as a result of finding meaning in social relationships and applying principles of ethical and moral reasoning.)

How do you best provide spiritual care to an infant? a. Meet basic feeding needs. b. Hold and rock the infant. c. Play with the infant using brightly colored soft objects. d. Set regular sleeping schedules.

B Spiritual care for an infant is to promote love and compassion.

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.

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.)

The nurse is caring for a Catholic patient who is going to surgery tomorrow. The patient states that she is afraid and asks the nurse to pray with her, although the nurse is not religious. What is the most appropriate response by the nurse? a. "I am not confident praying, but I will think about you tomorrow." b. "I need to take care of other patients right now, but I will be back." c. "I am uncomfortable praying. May I call the chaplain for you?" d. "I don't do that. Nurses are not allowed to do that at our hospital."

C (Offering to call the chaplain because the nurse is uncomfortable praying is the best option. Avoiding the subject or focusing on the nurse's feelings or needs is not appropriate and will not provide for the patient's stated spiritual need. )

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.

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.)

You are caring for a 65-year-old man with severe heart disease who is awaiting a heart transplant. It is during the Christmas season and he must stay in the hospital until the surgery or his death. His wife and physician consistently reinforce the severity of the situation and that he must stay in the hospital for tests. You are working the p.m. shift and he breaks down crying saying he doesn't want this and just wants to go home. What do you say? a. "If you go home, you will die." b. "What can I do to make your hospital stay better?" c. "You don't have to do this. What do you want to do?" d. "Can I call the chaplain for you?"

C (The patient is in spiritual distress looking for meaning and purpose in the situation. The nurse is helping the patient search for meaning.)

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

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.)

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

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.)

Qhat is transcendence? a. Out of body experience b. A meditative state c. A Higher Power d. Spiritual growth over time

D (Transcendence is moving beyond who you are toward who you will become. By definition, it is spiritual growth over space and time.)

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.

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.

The nurse has been caring for a patient who just died. The patient's daughter is crying uncontrollably, saying, "She was my best friend. I thought she would make it! I don't know what I am going to do." What is the nurse's best response? a. Express sympathy, and ask if she would like to talk with a chaplain. b. Give the daughter time to cry in her mother's room alone. c. Ask the daughter if her father is still living. d. Inquire if the daughter would like to pray.

a (At crisis times, spiritual advisors or chaplains are the best resource with the expertise to address family members' needs. Leaving the daughter alone or inquiring about her father would not provide the emotional support needed. The nurse should avoid making suggestions to the daughter but instead should seek to identify needs from the daughter's cues.)

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

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.)

7. 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

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.)

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?

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

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.)

A nurse assigned to the neonatal intensive care unit (NICU) has spent most of a day working with a critically ill infant, with the mother standing by. The infant experiences a cardiac arrest and does not survive. The mother spends an hour crying and holding the baby, saying good-bye. Which spiritual care intervention(s) is/are most appropriate for the nurse to implement? (Select all that apply.) a. If desired, briefly hold the baby to say good-bye after the mother leaves. b. Follow procedures to prepare the body for transport to the morgue. c. Visit the mother the next day to see how she is doing. d. Call the family spiritual adviser or the chaplain. e. Ask the mother if you could call a family member or friend to be with her.

a, d, e (It is important for nurses to take time to say "good-bye" to patients with whom they have developed a relationship. In this case, it would be appropriate for the nurse to hold the infant briefly, if desired, after the family has left before preparing the body for the morgue. With consent, the mother needs to be surrounded by appropriate persons to provide spiritual support, including a chaplain, family members, and friends. Although it is critical that the nurse follow procedures in preparing bodies for the morgue, it is not considered spiritual care. Visiting the mother after her loss could be viewed as a violation of professional boundaries, especially for a nurse who worked with the family for a day only.)

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.

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.

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

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

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.)

What is the most important aspect of providing spiritual care in nursing practice? a. Call a chaplain. b. Complete the FICA spiritual assessment and refer as needed. c. Recognize situations and patient behaviors indicating a spiritual need. d. Spend some time in self-reflection.

c (Changes in spiritual needs happen in the moment, and it is critical for nurses to recognize when a spiritual need arises. The FICA tool is not sensitive to daily changes in spiritual need. Calling a chaplain may be an appropriate intervention when the need arises. Nurses should integrate self-reflection in their own spiritual practices to find meaning in their life experiences, but that is not the best answer to the question.)

. 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.

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.)

Which statement by a patient best illustrates reflection on a spiritual need? a. "My husband told me what to do about this situation, and I'm sure he's right." b. "There is little I can do now to change my circumstances. I just need to adapt." c. "I need to think a little more about how I feel about undergoing this treatment." d. "Whatever the physician wants to do is fine. I don't have much of an option."

c (Reflection requires intentional thought about a situation to determine how it affects or is affected by the person's beliefs and values. Simply having someone tell the person what to do is not reflection, including adopting a fatalistic attitude or accepting the decision of a physician without inquiry.)

How do people who participate in organized religion differ from nonreligious people? a. Religious people are healthier than spiritual people. b. Religious people are more spiritual than nonreligious people. c. Religious people express their spirituality through faith traditions. d. Religious people have spiritual practices, whereas nonreligious people do not have spiritual practices.

c (Religious people express their beliefs through faith traditions. Research has not indicated that religious people are healthier or more spiritual than those who do not participate in organized religion. Nonreligious people may practice various spiritual disciplines.) LO: 22.2

The nurse is caring for a 16-year-old boy receiving chemotherapy for testicular cancer. He says that his parents are religious and left a cross next to his bed for "good luck." What is the most appropriate response by the nurse? a. "Would you like to talk with a chaplain?" b. "Sounds like you are not very religious." c. "How well do you get along with your parents?" d. "What helps you get through tough times?"

d (Asking an open-ended question is the best response that the nurse can make to this patient's comment. It will encourage the patient to share what he thinks would be most supportive at this time. Asking the patient if he would like to talk with a chaplain is incongruent with his comment about having a cross for good luck. Sharing that he does not sound religious is judgmental, and asking about his relationship with his parents is changing the subject.)

A Buddhist patient has end-stage pancreatic cancer. In what spiritual practice would this patient most likely engage? a. Reading passages in the Vedas b. Visiting with the patient's guru c. Practicing tai chi d. Meditating on the meaning of life

d (Buddhists believe in meditation. Vedas is associated with the Hindu faith, a guru is associated with Sikhism, and tai chi is an exercise, not appropriate at end of life.)

THe nurse is caring for a 45-year-old woman who is a breast cancer survivor. What activity associated with her cancer experience will promote this patient's spiritual well-being? a. Attending church every week b. Ensuring she follows her medication regimen c. Genetic testing on family members d. Speaking about her cancer experience to increase breast cancer awareness

d (Speaking about her experience helps promote meaning and purpose in life. Church attendance does not guarantee time of spiritual reflection related to her breast cancer experience. Treatment and genetic testing assist in physical treatment and risk identification but do not necessarily relate to finding meaning and purpose.)

at 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.

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.)

When caring for patients who are Jewish, how best can the nurse address their religious needs? a. Order a kosher diet. b. Allow time for prayer before each meal. c. Ask about religious holidays, particularly religious practices around the Sabbath. d. Ask about religious practices affecting care.

d (There are a variety of levels of observance within the Jewish community. It is best to ask patients about what practices will affect their care. Do not assume that all Jews are equally observant.)