Ch. 21 - Ethnicity - Sherpath, Evolve, EOC, chapter 42: death and loss, Chapter 29, 230 Final Exam Review

The nurse is assessing an Asian patient with arthritis. The patient asks the nurse about the benefits of alternative therapies for arthritis. Which response made by the nurse would demonstrate ethnocentrism? "Some alternative therapies might prove useful for your condition." "The health care provider may prescribe a Western therapy." "Alternative therapies are not as useful as current Western therapies." "There can be some side effects when using alternative therapies."

"Alternative therapies are not as useful as current Western therapies." Ethnocentrism refers to the belief that one's own cultural practices are better than those of other cultures. For the nurse to inform the patient that alternative therapies are not as useful as Western therapies is an ethnocentric view. Saying that some alternative therapies are useful demonstrates the nurse's cultural sensitivity. Informing the patient that the health care provider may prescribe a Western therapy does not indicate ethnocentrism because the nurse is only informing the patient about the treatment options. Informing the patient about the side effects of alternative therapies indicates that the nurse is helping the patient make an informed decision.

The nurse is educating the patient about the use of heat/cold therapy at home. The following statement by the patient indicates the need for further education? a. "I should fill my ice bag 2/3 full of ice." b. "I should use distilled water in my Aqua-K pad." c. "I can warm up my hot pack in the microwave." d. "I should check the order for how long to leave the compress on."

"I can warm up my hot pack in the microwave." Warm compresses and water for soaks should not be heated in the microwave unless the product and microwave are specifically designed for this type of heating. Ice bags are filled two thirds full, distilled water is used in Aqua-K pads, and application time for heat is as stated in the PCP order (for cold, it is a maximum of 20 to 30 minutes).

The nurse is explaining to the student nurse the purpose of occlusive dressings. Which statement by the student nurse indicates a lack of understanding? a. "Occlusive dressings are used for autolytic debridement." b. "Hydrocolloids are a type of occlusive dressing." c. "Occlusive dressings can be used on infected wounds." d. "Occlusive dressings support the most comfortable form of debridement."

"Occlusive dressings can be used on infected wounds." Occlusive dressings such as hydrocolloids and transparent films are used for autolytic debridement and are contraindicated in infected wounds. It is the most comfortable form of debridement for the patient.

The mother of two children, 8 and 10 years of age, has just experienced the death of her mother, the children's grandmother. The mother is concerned about the emotional impact attending the funeral may have on her children. She asks the nurse what she should do in relation to her children attending the funeral. What is the nurse's best response?

"Talk to your children about how they feel about attending the funeral and encourage them to ask questions and talk about their concerns. If they want to go, they will need to be prepared for what will happen at the funeral."

Which questions would the nurse include in an assessment using the Transcultural Assessment Model? Select all that apply. "What is your role in the family unit?" "What illnesses or diseases are common in your family?" "Do you feel it is important to be on time when you have an appointment?" "When you communicate with coworkers and others, how close do you stand?" "If you have something important to discuss with your family, how do you approach them?"

"What is your role in the family unit?" "What illnesses or diseases are common in your family?" "When you communicate with coworkers and others, how close do you stand?" "If you have something important to discuss with your family, how do you approach them?" The Transcultural Assessment Model helps assess different domains in a culture. The nurse assesses the social organization by asking about the patient's role in the family. The nurse assesses biological variations by asking about illnesses in the family. Asking how close the patient stands while interacting with people assesses the acceptable space during an interaction. Asking the patient the method of approaching the family for a discussion helps assess the communication patterns in a culture. Asking about the importance of punctuality is a closed-ended question and may be interpreted negatively by the patient. Instead, the nurse can assess the time domain by asking the acceptable arrival time to a meeting or an appointment.

The nurse is repositioning her patient in the side-lying position. To avoid putting the patient at risk for pressure ulcers, the HOB should be placed at: a. flat. b. 90 degrees. c. 30 degrees. d. 45 degrees.

30 degrees When side-lying, patients should be positioned at 30 degrees, as opposed to 90 degrees, to avoid positioning the patient directly on bony prominences such as the head of the trochanter.

The nurse knows to irrigate a deep wound with: a. A 5-mL syringe. b. A 10-mL syringe. c. A 3-mL syringe. d. A 30-mL syringe.

A 30-mL syringe. A deep wound is irrigated with a 30- to 50-mL piston syringe with an 18-gauge angiocath. Unlike the 1 pound per square inch (psi) of pressure or less that is delivered by a standard bulb syringe, the use of a 30- to 50-mL syringe and 18-gauge catheter has been shown to achieve an irrigation force that falls within the recommended 4 to 15 psi (Rodeheaver and Ratcliff, 2007).

Which patient demonstrates acculturation? An Indian mother who asks her child to touch an elder's feet to receive blessings A Latino patient who expresses suspicion and disapproval of Western treatments A Korean student in the United States who observes both Thanksgiving and traditional ancestral spirituality A Senegalese immigrant to the United States who speaks fluent English and has abandoned traditional medicine

A Korean student in the United States who observes both Thanksgiving and traditional ancestral spirituality Acculturation refers to the process whereby cultural groups exchange practices when they come in contact with one another but remain distinct. A Korean adolescent who migrates to the United States and celebrates Thanksgiving as well as practices ancestral veneration has adopted aspects of the new culture without abandoning the culture of origin. A mother who asks her child to touch an elder's feet for blessings is teaching a cultural practice. This is referred to as enculturation. Expressing disapproval of Western treatments indicates a patient's inability to accept the health practices of another culture. A West African (Senegalese) immigrant who speaks fluent English and has abandoned traditional medicine has merged with U.S. culture to the extent of losing aspects of the culture of origin; this is the process of assimilation.

Which of the following older adult patients is most appropriate for hospice care?

A patient who experienced a stroke and has been given 3 months to live

The nurse knows that a hydrocolloid dressing is appropriate for the following type of wound: a. A wound with a large amount of drainage b. A wound that is tunneling c. A postsurgical incision with staples d. A wound with a moderate amount of drainage

A wound with a moderate amount of drainage Hydrocolloids are occlusive, adhesive dressings composed of gelling agents and carboxymethylcellulose. They absorb a small to moderate amount of drainage over a 3- to 7-day period, forming a gel as drainage is absorbed. A wound with a large amount of drainage would require a foam or alginate dressing, a postsurgical incision with staples could use Steri-Strips or gauze, and a wound that is tunneling may require packing.

The nurse knows that the following factors contribute to the development of wounds and lead to delays in wound healing: (Select all that apply.) a. A patient who has diabetes b. A patient with COPD on long-term steroid therapy c. A patient with on bed rest who is repositioned d. A patient who is obese and sweats excessively

ALL Factors that contribute to the development of wounds and lead to delays in wound healing include comorbidities such as vascular disease, which impacts the skin's ability to obtain required oxygen and nutrients, or diabetes, which affects not only the microvasculature, but also the skin's normally acidic pH; malnutrition involving inadequate proteins, cholesterol and fatty acids, and vitamins and minerals; medications such as steroids, nonsteroidal antiinflammatories, and anticoagulants; excessive moisture from sweating; and external forces such as pressure, shear, and friction that occur when turning and repositioning the patient in bed.

The nurse knows that the cause of pressure ulcers includes the following factors: (Select all that apply.) a. Intensity of the pressure b. Duration of the pressure c. The tissue's ability to tolerate the pressure d. The person's age

ALL The primary cause of pressure ulcers is, as the name suggests, pressure. However, it is more than just pressure; it is the intensity of the pressure, the length of time that the tissue is subjected to the pressure, and intrinsic and extrinsic factors that affect the tissue's ability to withstand or tolerate that pressure. Intrinsic and extrinsic factors can include nutrition status and age.

Which statement describes the difference between assimilation and acculturation? Acculturation begins at birth; assimilation takes place when an individual migrates to another place. Acculturation does not involve cultural change; assimilation involves significant changes to one culture. Acculturation refers to distinct cultures exchanging features; assimilation involves the merging of cultures. Acculturation occurs unconsciously; assimilation is a conscious, deliberate process.

Acculturation refers to distinct cultures exchanging features; assimilation involves the merging of cultures. Acculturation occurs when there is an interaction between two cultures and an exchange of cultural features takes place. Assimilation occurs when one cultural group merges with a dominant cultural group. Both acculturation and assimilation take place when one culture interacts with another and not at birth. Acculturation and assimilation both bring about a change in the cultural practices of a group. Acculturation and assimilation are conscious as well as unconscious processes as the contact between the cultural groups brings about a change in the language, technology, food, and clothing.

Which factor is required in the delivery of culturally congruent care? Learning about every culture Motivation and commitment to caring Influencing treatment and care of patients Acquiring specific knowledge, skills, and attitudes

Acquiring specific knowledge, skills, and attitudes Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care. It is not feasible for the nurse to learn about every culture; however, the nurse should learn about the cultures prevalent within his or her community. Motivation and commitment to caring embodies the characteristics of a nurse, not necessarily for the delivery of culturally congruent care. Nursing as a whole influences nurses to care for and treat patients with respect and dignity.

A nurse is caring for a patient who is a devout Muslim. The nurse enters the patient's room to administer a scheduled intravenous medication; however, the nurse finds the patient preparing for namaz (prayers). Which action by the nurse is acceptable? Administer the drug while the patient prays. Ask the patient to pray after the medication is administered. Allow the patient to pray and come back later to administer the medication. Tell the patient that the nurse cannot come later as the nurse has other patients to look after.

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 prayers and then administer the medication. It would be inappropriate to administer the drugs while the patient is praying because it would show disrespect to the patient. It would be inappropriate for the nurse to ask the patient to delay prayer, because the patient's culture dictates that prayer be performed at specific times. The nurse should not express to the patient that the nurse has other patients.

A patient uses one-word answers and broken English phrases during an interview with the nurse. As a result, the nurse is unable to understand the patient's concerns. Which action should the nurse take? Arrange for an interpreter. Observe any nonverbal cues. Request a colleague to assist. Interview the patient's spouse.

Arrange for an interpreter. The use of short and broken English phrases indicates that the patient is unable to communicate fluently in English. Therefore the nurse should arrange for an interpreter to avoid any misunderstanding of the patient's condition. The nurse may be able to obtain information from the patient's nonverbal cues. However, it may not be enough, as the patient may need to express health concerns. Asking a colleague to help does not solve the problem if the colleague is not fluent in the patient's native tongue. The nurse may interview the patient's spouse to obtain additional subjective information. Nevertheless, the nurse should also obtain primary information from the patient to understand the patient's condition.

The nurse asks a Chinese-American patient who was recently diagnosed with hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head yes. Which action should the nurse take next Ask the patient how much salt he is consuming each day. Discuss the health implications of sodium and hypertension. Remind the patient that many foods such as soy sauce contain "hidden" sodium. Suggest some low-sodium dietary alternatives.

Ask the patient how much salt he is consuming each day. It is important for the nurse to clarify how much salt the patient is consuming in his diet, as this directly relates to the diagnosis of hypertension. In the Chinese culture, making direct eye contact is considered a sign of disrespect. This culture will instead lower their head and avoid eye contact when someone in authority is speaking. The patient is showing respect by not making eye contact and nodding his head. The nurse would discuss the health implications of sodium and hypertension; however, this would not be the next step. The nurse would remind the patient of foods that are high in sodium; however, this should not be the nurse's next step. The nurse would suggest low-sodium alternatives to the patient; however, this should not be the nurse's next step.

Which action by the nurse demonstrates unbiased and culturally sensitive care to a patient? Teaching an Asian patient to discontinue the art of coining Asking the dietitian to remove pork from the diet of a Muslim patient Explaining the drawbacks of folk medicine to an African-American patient Describing the importance of modern Western medicine to a Latino patient

Asking the dietitian to remove pork from the diet of a Muslim patient Middle Eastern patients do not include pork in their diet; removing it from the menu demonstrates culturally competent care. Teaching an Asian patient to discontinue the art of coining is disrespectful and culturally insensitive. Many African-American patients believe in the efficacy of folk medicines; therefore informing them about the disadvantages of folk medicine indicates a lack of cultural sensitivity. Describing the importance of Western medicine demonstrates that the nurse is culturally insensitive to the belief that traditional healing practices may be preferred due to a mistrust of the medical establishment in the Latino culture.

Which initial action should the nurse take to provide effective cultural care in a community setting? Observe the patient's socialization patterns. Assess patients in their normal environment. Acquire knowledge of several different cultures. Use theoretical frameworks of transcultural care.

Assess patients in their normal environment. A community setting will have patients from diverse cultures and socioeconomic levels. Acquiring knowledge about a community's culture begins by conducting a careful assessment of patients and their families in their own environment. Observing socialization patterns will help the nurse understand only the social element of culture and will not help provide culturally congruent care. Obtaining knowledge of different cultures is not enough for providing effective care. Using theoretical frameworks of transcultural care helps develop culturally congruent care plans; however, it will not help the nurse understand the patient's concerns in a community. The nurse should also evaluate other factors like community resources, socioeconomic problems, and psychological factors.

A 5-year-old African child is adopted by an American couple and slowly adapts to American society. Which process is this known as? Biculturism Assimilation Enculturation Ethnocentrism

Assimilation Assimilation is a process in which people belonging to a minority culture adopt the culture of the dominant group. The adopted child slowly adapts to the new American identity. Biculturism occurs when a person adopts the characteristics of two cultures. Enculturation occurs when an individual socializes in his or her own culture. Ethnocentrism is the belief that one's culture is superior to others.

Which action by the nurse demonstrates prejudicial behavior? Using an interpreter to communicate with a Latino patient Assuming that all patients of Asian descent are materialistic Informing a colleague about unusual habits noted in a patient Expressing disapproval to a patient regarding certain rituals

Assuming that all patients of Asian descent are materialistic Prejudicial behavior refers to the process of devaluing an entire cultural group due to assumed attributes. For example, assuming that all Asians are materialistic is prejudicial thinking because many Asians do not display this behavior. Using an interpreter to communicate with a Latino patient will help prevent misunderstandings. Informing a colleague about a patient's unusual habits may be necessary to communicate cultural practices followed by the patient; it does not indicate prejudicial behavior. Expressing disapproval to a patient about certain rituals shows a lack of cultural sensitivity by the nurse, but is not necessarily prejudicial, which usually involves negative labeling of an entire group of people.

To enhance cultural awareness, nursing students need to make an in-depth self-examination of which attributes? Motivation and commitment to caring Social, cultural, and biophysical factors Engagement in cross-cultural interactions Background, recognizing personal biases and prejudices

Background, recognizing personal biases and prejudices Cultural awareness is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people. Motivation and commitment to caring is an overall nursing characteristic. Cultural competence is the ability to interact with and appreciate people of different cultures and beliefs.

Which food items should likely be avoided in the diet plan for a Muslim patient? (Select all that apply.) Bacon Lobsters Cod liver oil Marshmallows Green leafy vegetables

Bacon Marshmallows Bacon is derived from a pig, and pork is forbidden in the Muslim culture. Marshmallows contain gelatin, which is a pork byproduct; therefore it should be avoided as well. Lobsters, green leafy vegetables, and cod liver oil all are acceptable for consumption by Muslims.

A nurse develops a nursing diagnosis for a patient. Which factor can cause a culturally insensitive diagnosis? Cultural bias Medical history Generalization Cultural care repatterning

Cultural bias The nurse's cultural biases can affect the accuracy of the nursing diagnosis, leading to a culturally insensitive diagnosis. This is because the nurse may not be able to understand the reasoning behind the patient's behavior. The patient's medical history will help in formulating an accurate nursing diagnosis, as it helps understand the patient's current condition. Generalizing will not adversely affect the nursing diagnosis; it helps anticipate and understand patient behaviors. Cultural care repatterning respects the patient's cultural values while helping the patient adopt new and different health care patterns for a healthier life.

1. The nurse has been caring for a patient who has just died. What is the preferred outcome in caring for the body after death?

Demonstrate respect for the body and provide a clean, peaceful impression of the deceased for the family.

The nurse is planning an educational program for an immigrant population. Which nursing action will enhance the effectiveness of the program? Developing cross-cultural linguistic competencies Asking colleagues to assist in teaching the class Encouraging people to rely on Western therapies Including only English-speaking people in the class

Developing cross-cultural linguistic competencies Experts have noted that in addition to cultural competence, linguistic competence is needed to offer appropriate care and responses to culturally diverse patients. The use of certain words may be specific to a culture, and the nurse needs linguistic competence to prevent any misunderstanding. Asking colleagues to assist in the teaching is ineffective if those colleagues lack linguistic competence. Encouraging people to rely on Western therapies indicates an ethnocentric view. Including only English-speaking people in the program demonstrates the nurse's bias, which is not good nursing practice.

A nurse is caring for a Hispanic male who has tattoos all over his body. The nurse tells her coworker, "I guarantee you this patient is a drug dealer." This statement can be described as which term or phrase? Discrimination Delivery of culturally congruent care Effective intercultural communication Sufficient comparative knowledge of diverse groups

Discrimination Prejudices associate negative permanent characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs. If the nurse applies a stereotype and assumes that all people with a group will act in a predetermined manner, he or she has committed discrimination. The nurse did not deliver culturally congruent care, nor did she develop effective intercultural communication. The nurse used stereotyping and discrimination based on the patient's ethnicity and appearance. The nurse did not compare knowledge of diverse groups before making the discriminating statement.

END OF CHAPTER QUESTIONS

END OF CHAPTER QUESTIONS

EVOLVE ONLINE ONLY QUESTIONS

EVOLVE ONLINE ONLY QUESTIONS

The nurse observes that a 2-year-old American child slowly grows into the American society that the child lives in. What is this process of socialization into one's primary culture known as? Biculturism Assimilation Enculturation Acculturation

Enculturation Enculturation is a process whereby a culture is passed from generation to generation. It begins at birth as parents and family members begin to teach the child what is expected in terms of familial responsibility and contributions. Biculturism occurs when a person follows two cultures. Assimilation occurs when a member of a minority culture takes on the culture of the dominant group. Acculturation occurs when an individual takes on the culture of a different group.

A 2-month-old child from Guatemala was adopted by an American family in Indiana. Which term best describes the child's socialization into the American Midwestern culture? Assimilation Acculturation Biculturalism Enculturation

Enculturation Socialization into one's primary culture as a child is known as enculturation. Assimilation is the process by which individuals from one cultural group merge with or blend into a second group. Acculturation is a mechanism of cultural change achieved through the exchange of cultural features resulting from first-hand contact between groups. Biculturalism describes the coexistence of two distinct cultures.

The nurse knows that mechanical debridement involves all of the following except: a. wet to dry dressings. b. whirlpool baths. c. damp to dry dressing. d. enzymatic dressing.

Enzymatic debridement It is achieved through the application of topical agents containing enzymes that work by breaking down the fibrin, collagen, or elastin present in devitalized tissue, thus allowing for its removal. Mechanical debridement is a nonselective form of debridement because it not only removes the necrotic tissue, but also can remove or disturb exposed viable tissue that may be in the wound. The main forms of mechanical debridement are wet/damp-to-dry dressings and whirlpools.

A Jamaican immigrant has been late to the last two clinic visits, which in turn had to be rescheduled. Which nursing action is most appropriate to help prevent the patient from being late to the next appointment? Give the patient a copy of the city bus schedule. Call the patient the day before the appointment as a reminder to be on time. Explore what has prevented the patient from being at the clinic in time for the appointment. Refer the patient to a clinic that is closer to the patient's home.

Explore what has prevented the patient from being at the clinic in time for the appointment. Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. The nurse should assess the reason for tardiness to determine whether it is due to cultural factors or to reliance on public transportation or other means over which the patient has little control. Nurses need to expect conflicts and make adjustments when caring for ethnic groups. Giving the patient a copy of the city bus schedule does not address the reason for the patient being late. Calling the patient the day before the appointment may be beneficial; however, this culture practices present-time orientation. Referring the patient to a clinic closer to the patient's home may be beneficial; however, this is not the clinic the patient chose to use.

Which terms are the basic elements of culture? (Select all that apply.) Shared Learned Symbolic Biological Integrated

Shared Learned Symbolic Integrated Culture has four recognizable elements: learned, symbolic, shared, and integrated. A person learns the different values and beliefs of the culture and transmits them to the next generation. Culture is based on different symbols, such as language, dress, flags, and religion. The people in a cultural group share the same set of ideals, beliefs, and values. Cultures are integrated, patterned systems working together to keep the culture strong. Culture is not biological; it is learned.

The nurse assumes that an Asian patient with bruises on the back is experiencing abuse. However, the patient does not look scared and speaks to the nurse confidently. Which further assessment should help the nurse best understand the patient's condition? Gender role Health care practices History of alcohol abuse Communication patterns

Health care practices The patient's emotional condition is in contrast with the objective data that the nurse collects. Therefore the nurse should assess the patient's health care practices, as Asians may engage in coining and cupping, which may leave bruises on the skin. The patient's gender role will not help the nurse understand the cause of bruises on the patient's back. Alcohol abuse is not relevant to the patient's condition in this case. Understanding the patient's communication patterns will not help the nurse understand the cause of the bruises.

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department and detects disparities in health outcomes between the rich and poor. Which phrase best describes this disparity? Illness attributed to natural and biological forces Creation of the student's interpretation and descriptions of the data Influence of socioeconomic factors in morbidity and mortality Combination of naturalistic, religious, and supernatural modalities

Influence of socioeconomic factors in morbidity and mortality Health disparity populations are populations that have a significant increased incidence or prevalence of disease or that have increased morbidity, mortality, or survival rates compared to the health status of the general population.

During an assessment of a patient, the nurse finds that the patient speaks a different language and that an interpreter is needed. Which technique would the nurse use to communicate with this patient? (Select all that apply.) Direct the questions to the interpreter. Introduce herself to the patient. Introduce the interpreter to the patient before introducing herself. Observe the patients' nonverbal and verbal behaviors. Ask the interpreter to ask the patient for feedback and clarification.

Introduce herself to the patient. Observe the patients' nonverbal and verbal behaviors. Ask the interpreter to ask the patient for feedback and clarification. A nurse should use transcommunication skills to effectively provide care for the patient. Even if the interpreter is present, the nurse should introduce herself to the patient. Observing the patients' nonverbal and verbal behaviors helps in communication. Requesting that the interpreter ask the patient for feedback at regular intervals helps assess the clinical and cultural data in detail. As a rule, the nurse should direct questions to the patient. The nurse is the primary caregiver; therefore the nurse should first introduce herself and then the interpreter.

Which assessment finding is a symbolic aspect of culture for a patient? Language Occupation Infrastructure Gender roles

Language Language is a system of verbal symbols that is used to communicate cultural beliefs and ideas. Occupation is not culture specific. An infrastructure provides the basic necessities of life and is a required aspect of an integrated culture; it is not symbolic. Culture assigns different roles to people according their gender. However, it is not symbolic, but a concept shared by the people in that culture.

A patient is admitted to the hospital. Which characteristics would help the nurse identify the ethnicity of the patient? (Select all that apply.) Language Personal beliefs Geographical space Political orientation Socioeconomic status

Language Geographical space Ethnicity refers to a shared identity relative to social and cultural heritage such as values, language, geographical space, and racial characteristics. Members of an ethnic group feel a common sense of identity. Personal beliefs, political orientation, and socioeconomic status do not describe ethnicity.

A nurse finds that an Asian patient has assimilated into the American culture. Which unique characteristics of the patient's culture may be altered in the process of assimilation? Select all that apply. Language Values Customs Health beliefs Religious practices

Language Values Customs Assimilation occurs when people are absorbed into a new culture. In the process of assimilation, people may lose some of their unique characteristics, such as language, values, and customs. Health beliefs and religious practices are usually preserved in the process of assimilation and remain unaffected by the new culture.

After speaking to a patient with depression, the nurse observes that the patient is experiencing discrimination. Which patient statement helped the nurse arrive at this conclusion? "My boss fired me when I admitted that I'm gay." "My friends have stopped talking to me for at least a year." "My neighbors seem to dislike me for no apparent reason." "My parents rarely call me or express any wish to see me."

My boss fired me when I admitted that I'm gay." Discrimination refers to policies or actions that negatively affect a group or an associated individual. In this case, the patient experienced concrete discrimination on the basis of sexuality in the form of loss of employment. The friends may have stopped talking to the patient due to some disagreement or other social issues; however, that does not indicate that the patient is experiencing discrimination. The patient may perceive that the neighbors are rude or do not like the patient; however, there is no evidence that this is true. If the parents do not call or see the patient, it indicates family issues that need further assessment.

A nurse is caring for a middle-aged Hindu Asian patient following an incidence of high blood pressure. After reviewing the patient data, the nurse concludes that the patient's health care practices and health care needs are not congruent. Which action by the nurse should provide culturally congruent care? (Select all that apply.) Negotiate for a change in his cultural practices. Preserve the patient's values relevant to maintaining his health. Develop a standard care plan applicable for each patient. Modify the patient's lifestyle to develop a beneficial health care pattern. Tell the patient that his cultural practices are unhealthy and must change.

Negotiate for a change in his cultural practices. Preserve the patient's values relevant to maintaining his health. 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 care 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 honor his culture while improving his health.

Which advice from an experienced nurse will help a new graduate nurse enhance cultural competency? Obtain in-depth knowledge about medical concepts and nursing care. Learn at least three foreign languages. Obtain sufficient knowledge about a patient's cultures and beliefs. Learn about various dialects prevalent in the country.

Obtain sufficient knowledge about a patient's cultures and beliefs. It is extremely important for the nurse to be culturally competent. The nurse should obtain knowledge about various cultures and cultural practices prevalent in the population. This will serve the nurse well as he or she attempts to understand the patient's cultural practices and in turn provide better care. The nurse should already possess medical and nursing knowledge as he or she holds a nursing license. It is not mandatory for nurses to know foreign languages, though it may be helpful in the long term. Knowledge of languages and dialects is not sufficient; however, the nurse should learn about and respect culture.

The nurse is developing a transcultural care plan for an Asian patient who identifies with both his native and American culture. Which components would the nurse incorporate in order to provide culturally congruent care? Select all that apply. Ignoring biophysical differences of patients from different cultures Obtaining knowledge of the patient's health beliefs Self-examining his or her own culture Working in another country to learn new nursing practices Being open and accepting of cultural differences

Obtaining knowledge of the patient's health beliefs Self-examining his or her own culture Being open and accepting of cultural differences The patient, who identifies with both his native and American cultures, has attained biculturalism. The goal of transcultural nursing is to provide culturally congruent care. Obtaining knowledge of the patient's health beliefs (cultural knowledge) and self-examination of one's own culture (cultural awareness) are important for delivery of culturally congruent care. The nurse should be open and accepting of cultural differences (cultural desire) in order to understand them, and plan the care accordingly. It is important to understand the biophysical differences of various cultures as they may influence the care of the patient. It is not necessary to work within another country to learn new practices, but it is helpful to engage with others from different cultures.

Which patient data will the nurse consider while preparing a care plan for a Jehovah's Witness patient? Literacy Preferences Acculturation Medical knowledge

Preferences Nurses caring for known members of the Jehovah's Witness faith community should document patient preferences to ensure compliance with religious beliefs during medical treatment. The patient's literacy and medical knowledge do not influence the care process but do affect teaching. Acculturation does not refer to patient data; it is a process of interaction and cultural exchange between two or more cultures.

A nurse is caring for a Muslim patient who is recovering from a motor vehicle accident. The nurse understands that a high-protein diet is important for the patient's wounds to heal; however, the patient is following Ramadan. When constructing a diet plan for this patient, which factors should the nurse consider? Select all that apply. Reschedule meals. Ask the patient's closest relative to ask him not to fast. Start enteral tube feedings if the patient refuses to take food orally. Respect the cultural beliefs and assure the patient that medical needs will be taken care of. Try and convince the patient not to fast as it will affect recovery.

Reschedule meals. 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. Islamic followers fast during Ramadan. Therefore the nurse should not assume that the patient will take regular meals during that period. Likewise the treatment and medication regimen should be rescheduled according to the cultural needs. The cultural beliefs should be respected and the patient should be assured that the hospital staff will ensure that the patient receives optimal care. Asking the patient's relative to ask the patient not to fast would be emotionally disturbing. Starting enteral tube feedings is also not ethical as they would be against the patient's will. Trying to convince the patient to have meals may make the patient believe that the nurse is disrespecting personal beliefs.

An older Chinese woman is admitted to the hospital after a hip fracture. The nurse encourages the patient to walk about the room; however, the patient refuses to walk without her son. Which action by the nurse is culturally congruent? Leave the patient alone but understand that the patient has no self-confidence. Respect the patient's wish and ask her to walk when her son is present. Explain to the patient calmly that she can't be dependent on her son. Tell the patient that she needs to walk now.

Respect the patient's wish and ask her to walk when her son is present. In some cultures, families make decisions together. This patient may only be comfortable when her son is present; therefore the nurse should respect the patient's wishes and come back when the son is there. This patient is not lacking confidence. The patient is not comfortable without her son present. It is not therapeutic to speak sternly with the patient and tell her that she is dependent on others. The patient has the right to refuse care; therefore the nurse should not demand that the patient walk now.

Which nursing action acts as a barrier to the patient-nurse relationship? Stereotyping Generalizing Speaking slowly Respecting cultures

Stereotyping Stereotyping, or having fixed negative ideas about patients who belong to a particular cultural group, acts as a barrier to the patient-nurse relationship. It makes the nurse less likely to make an effort to understand whether that perception really applies to that individual patient. The nurse applies generalizations when certain traits are consistent in people who belong to a similar group or culture. If applied correctly, these generalizations do not hamper the patient-nurse relationship, but help anticipate behaviors. The nurse speaks slowly while interacting to provide additional time for the patient to process the information. Respecting cultures refers to the process of understanding different cultural health practices and providing culturally congruent care.

The nurse is performing a wet/damp to dry dressing change when the patient begins to complain of severe pain. What should the nurse do first? a. Notify the physician. b. Notify the wound care nurse. c. Stop the procedure. d. Give the patient pain medication.

Stop the procedure. If the patient is complaining of severe pain, the nurse should first stop the procedure and then determine if the pain is new or preexisting. Then the nurse can determine what to do next based on the patient's response.

The nurse is caring for a patient with a Penrose drain. She knows the patient will require the following care: a. The drain must be compressed after emptying to work properly. b. The drain must be connected to suction if ordered. c. The drain is not sutured in place so care is taken to not dislodge it. d. The suction pulls drainage away from the wound as it re-expands.

The drain is not sutured in place so care is taken to not dislodge it. The Penrose drain, an open drain that is a flexible piece of tubing, is usually not sutured into place and is not connected to suction. Closed drains are compressed or connected to suction if ordered and pull drainage away as they expand.

A Muslim patient refuses to eat the pork that was served on his dinner tray. Which statement offers an explanation for this? The nurse lacks appropriate communication skills. The nurse has failed to plan culturally congruent care. The nurse is prejudiced against the patient's culture. The nurse has exhibited racist behavior during the interaction.

The nurse has failed to plan culturally congruent care. The nurse shows a lack of cultural competence, as Middle Eastern patients are likely to consider pork as taboo. Therefore the nurse needs to consider such patient preferences and find alternative foods to incorporate into the patient's diet. The patient is not offended because of the nurse's communication skills, but due to the nurse's lack of cultural sensitivity. Prejudicial thinking refers to the process of devaluing an entire cultural group due to assumed attributes. Racism refers to the act of considering a patient or a group superior based on race.

A patient tells the nurse, "I don't want any Western medicines because they contain too many chemicals. I prefer folk medicine because it has no side effects." The nurse informs the patient that all folk medicine is harmful because it contains poisonous herbs. Which statement describes the nurse's behavior? The nurse lacks cultural competence. The nurse is providing medical information. The nurse is prejudiced against the patient. The nurse demonstrates evidence-based practice.

The nurse lacks cultural competence. The patient prefers folk medicine because it has no side effects. However, the nurse is suggesting that the patient's health care practices are not appropriate, indicating a lack of cultural competence. The nurse is not providing medical information because there are certain folk remedies that work well. The nurse is not prejudiced against the patient (devaluing an entire group) but believes that Western medicine is better and safer than folk medicine (ethnocentrism). The nurse is not using evidence-based practice in this case, as the nurse demonstrates incomplete knowledge about folk medicine.

The nurse observes that an elderly Hispanic patient frequently nods his head and consistently says, "OK. I understand," while learning about the medication schedule. Which conclusion would the nurse make regarding the patient's behavior? The patient is paying attention to the instructions. The patient shows active participation in learning. The patient may not have comprehended what was taught. The patient responds in a way unique to the culture.

The patient may not have comprehended what was taught. Patients who hear the instructions but may not have comprehended them may frequently nod their head and constantly respond that they heard the instructions. Therefore the nurse needs to ask questions or ask the patient to do a return demonstration to determine whether the teaching was understood. While the patient may be trying to pay attention to the instructions; comprehension should not be taken for granted without additional confirmation. The combination of frequent nodding and positive verbal responses despite a lack of understanding is not seen in any specific culture. Questions or suggestions by the patient would indicate active participation in the learning process.

Why would a nurse apply generalizations while assessing a patient? To prevent likely patient discrimination To develop patient-centered care plans To anticipate certain patient behaviors To refrain from any patient stereotyping

To anticipate certain patient behaviors A generalization is a statement that has a broad application, allowing the nurse to understand and anticipate certain patient behaviors. The nurse applies generalizations when certain traits are consistent in people who belong to a similar group or culture. Discrimination refers to the process of judging a patient on the basis of stereotypes. Generalizing does not help develop a patient-centered care plan; however, it helps anticipate patient behaviors. Generalizations may lead to stereotyping if the nurse does not consider the individual differences among individuals within a culture.

Which measures should the nurse adopt to ensure effective communication when caring for a non-English-speaking patient? Select all that apply. Patronize and comment on the patient's culture. Speak to the interpreter instead of the patient. Understand cultural and language differences. Avoid interpreting based on personal cultural beliefs. Provide written information in the primary language.

Understand cultural and language differences. Avoid interpreting based on personal cultural beliefs. Provide written information in the primary language. Understanding cultural and language differences helps the nurse appreciate and respect differences in the patient's behavior. The nurse should avoid making interpretations based on his or her own cultural beliefs, as there are differences in cultures, communication, and behavior patterns. Providing written information in English and the primary language can help the patient understand instructions better. The nurse should avoid patronizing and commenting on any culture to avoid any bias or feeling of disrespect. It is better that the nurse speaks directly to the patient even in the presence of an interpreter, as it helps maintain respect and effective communication.

The nurse knows a stage III pressure ulcer is: a. a pressure ulcer that involves exposure of bone and connective tissue. b. a pressure ulcer that does not extend through the fascia. c. a pressure ulcer that does not include tunneling. d. a partial-thick wound that involves the epidermis.

a pressure ulcer that does not extend through the fascia. Stage III pressure ulcers are full-thickness wounds that extend into the subcutaneous tissue but do not extend through the fascia to muscle, bone, or connective tissue. There may be undermining or tunneling present in the wound. Stage IV pressure ulcers involve exposure of muscle, bone, or connective tissue such as tendons or cartilage. Stage II pressure ulcers are partial-thickness wounds that involve the epidermis and/or dermis.

1. While caring for a female patient with advanced multiple sclerosis, the nurse is discussing the difference between hospice and palliative care. Which statement by the patient indicates understanding of the difference between hospice care and palliative care?

a. "I can get palliative care right now—even though I am not going to die anytime soon."

1. The nurse cares for dying patients and understands that "nearing death awareness" is a phenomenon evident by which patient statement(s)? Select all that apply.

a. "Where are my shoes? I need to get ready for the trip." a. "I was just talking to my daughter (deceased)."

The nurse is using the Braden scale to assess the patient's risk for a pressure ulcer. Which risk categories are associated with the Braden scale? (Select all that apply.) a. Activity b. Friction and shear c. Moisture d. Sensory perception e. Cognition

a. Activity b. Friction and shear c. Moisture d. Sensory perception The Braden scale ranks the patient on the risk categories of sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The scale does not include cognition.

1. In caring for a dying patient, what is an appropriate nursing action to increase family involvement?

a. Asking family members what they would like to do for their loved one and allowing them to participate

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. Asking the family's spiritual advisor to visit the patient 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.

1. Which statement is true regarding advance directives?

a. Discussion of advance directives is a nursing responsibility.

The nurse knows that cold therapy is contraindicated in the following conditions: (Select all that apply.) a. Edema b. Shivering c. Bleeding d. Circulatory issues

a. Edema b. Shivering d. Circulatory issues Cold should not be used if any of the following is present: edema (cold application slows reabsorption of the fluid), circulatory pathophysiology (cold application causes vasoconstriction, further reducing circulation to the area), and shivering (this is a comfort concern). Bleeding is contraindicated in heat therapy.

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

a. Explaining medical terms and verifying that the patient understands 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.

1. 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. 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.

4. Which of the following questions 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. How do you act when you are angry? b. What is your role in your extended family? d. When communicating with friends, how close do you stand? 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 should be assessed to raise the nurse's awareness of patient needs. Asking patients 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.

The nurse is performing a focused wound assessment on a patient. The following should be included in the documentation: (Select all that apply.) a. Location and size b. Characteristics of the wound bed c. Patient's response to wound treatment d. Patient's pain level e. Presence of drainage

a. Location and size b. Characteristics of the wound bed c. Patient's response to wound treatment e. Presence of drainage A focused wound assessment includes an evaluation of the wound's location, size, and color; presence of drainage; condition of the wound edges; characteristics of the wound bed; and patient's response to the wound or wound treatment. The patient's pain level would be documented with his/her pain assessment.

3. Which statements reflect 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. May be considered a general and specialty practice area c. Challenges traditional ethnocentric nursing practice d. Aims to identify individual patient care preferences Transcultural nursing is a general and specialty practice that focuses on both worldview 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.

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 counseling to help them communicate more clearly c. Providing hospital signage in several languages to help patients and families navigate d. Delegation of all patient and family care to health care professionals that are of the same ethnicity

a. Providing continuing education events focused on delivery of linguistic services CLAS Standards for Health Care recommend that health care organizations ensure that staff at all levels receive continuing education in linguistically appropriate services. 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. However, that is a small part of being culturally competent. It is impossible and unnecessary to delegate all care to persons of like ethnicity.

5. A patient prefers to seek acupuncture for pain relief before taking prescribed medication. What response by the nurse is most appropriate? 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. Recognize that alternative forms of treatment can be effective. 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.

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

a. Seeking to understand individual patient customs, beliefs, and values 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.

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 e. Cultural health practices

a. Susceptibility to illness b. Body frame and structure c. Existence of genetic disease 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 in the time domain. Cultural health practices are in the environmental control domain.

6. What aspect of culture is a full-time employed granddaughter of an elderly 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. System change 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 reflects societal changes that affect traditional culture expectations of one generation's providing care in the home. Shared attributes, cultural norms, and gender role are all challenged by the granddaughter's actions.

1. The nurse is orienting new staff to a clinical unit that provides palliative care. A new employee asks what "grief" is exactly. Which statement indicates that the nurse has correctly defined grief?

emotional response to loss

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 so the patient doesn't get charged for an interpreter. e. determine the patient's role and functions within the family.

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. e. determine the patient's role and functions within the family. 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. Roles in the family are important to patients from all cultures. Avoid translation of medical information by a patient's family members or friends to ensure privacy and accuracy of essential, personal information. Patients are not charged for translation services.

As a nurse, you evaluate how an individual is progressing through the process of grief, loss, and mourning and understand that a grieving individual is functioning effectively if he/she is: a. using distraction as a coping mechanism while avoiding contact with former friends who have not experienced a loss.

able to accept assistance and support of friends and family as needed during the time of loss and grief.

6. A nurse's role when communicating with a provider caring for a dying patient is:

advocate patient wishes

Mr. S. has recently lost his wife of 56 years after she had been diagnosed with terminal pancreatic cancer. Which of the following focused assessment questions is appropriate to ask when you suspect that Mr. S. may be experiencing dysfunctional grief?

b. "Do you feel that your sense of loss has gotten worse over the last year?"

2. 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. Asking the dietary intern to verify with Middle Eastern patients whether or not they eat pork c. Telling the radiology technician that every non-Hispanic family is late for appointments d. Assuming that extended families share financial responsibility for medical bills

b. Asking the dietary intern to verify with Middle Eastern patients whether or not they eat pork Middle Eastern people typically do not consume pork products. This generalization would be helpful to use as a baseline when caring for Muslim or Jewish patients. It is always important to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements regarding people of one culture is stereotyping and hurtful. Assuming anything without asking about patient traditions or preferences is inappropriate.

5. 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. Base decisions on feedback from the patient and the nurse's professional judgment. 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.

The nurse is caring for a postoperative orthopedic patient who has two Hemovac drains in place. Which interventions should the nurse perform? (Select all that apply.) a. Measure the amount of drainage in the device prior to emptying. b. Label each drain and record them separately. c. Recompress the device after emptying. d. Secure the device to the patient's gown above the level of the wound. e. Check for kinks in the tubing.

b. Label each drain and record them separately. c. Recompress the device after emptying. e. Check for kinks in the tubing. Use a marked, graduated measuring device to collect the drainage when emptying the reservoir to facilitate accurate measurement of the drainage. After emptying, recompress the device to maintain suction. Secure the container(s) to the patient's hospital gown below the level of the wound, avoiding tension on the tubing and making sure there are no kinks. If there are multiple drains, label them and document observations by the drain label.

8. 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, whiteboards, and gestures to communicate all important information. b. Verify patient understanding of questions asked when the patient responds with continuous affirmative answers. c. Arrange for a professional language translator to be present 24 hours each day. d. Decrease interaction with the patient and family to avoid making them uncomfortable for not understanding.

b. Verify patient understanding of questions asked when the patient responds with continuous affirmative answers. 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 a professional interpreter need not be present 24 hours a day. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.

5. Rather than simply providing physical care to patients, hospice was designed to:

improve quality of life

9. Which ICNP nursing diagnosis is most appropriate for a young 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. Impaired Family Process d. Difficulty Coping

c. Impaired Family Process A key factor in Impaired Family Process 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.

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.

c. Recognize one's own personal cultural heritage, patterns, and biases. 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.

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.

c. Slow down when speaking to articulate more clearly. 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.

8. A nurse is caring for a patient in the acute care setting who has a do-not-resuscitate order in place. The family approaches the nurse as he/she is walking down the hall and says, "I think my mother has died." To facilitate acceptance of the death by the family, an important nursing intervention is to:

c. assess the patient for pulse, respirations, or blood pressure with the family present.

Mr. Jones' young daughter died in a tragic car crash 1 year ago. Mr. Jones states that he still looks for his daughter when he drives by the playground of her former school and that he often misses work because of lack of sleep and intense feelings of grief. As a nurse, you understand that the type of grief Mr. Jones is experiencing is identified as:

complicated grief

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

d. Acculturation 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.

what are advanced directives>

d. Are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life.

10. 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.

d. Check with the patient on admission to determine dietary limitations and preferences. 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.

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.

d. Seek information to determine the underlying cause of the body odor. 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.

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. Sharing cultural expectations with younger family members 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.

The best way for a new nurse to cope with his/her own feelings related to death, loss, and grief while caring for patients is to: a. emotionally distance him/herself from dying patients and their families immediately after death has occurred.

develop a beginning awareness of his/her own fears, feelings, responses, and reactions to death and dying.

While working with patients in a hospice setting, the nurse is aware that certain symptoms are particularly common among patients near the end of life. Which of the following health problems should the nurse anticipate among dying patients?

dyspnea

The nurse knows the layer that delivers the blood supply to the dermis, provides insulation, and has a cushioning effect is: a. stratum germinativum. b. epidermis. c. subcutaneous layer. d. stratum corneum.

subcutaneous layer. The subcutaneous layer delivers the blood supply to the dermis, provides insulation, and has a cushioning effect. The stratum germinativum constantly produces new cells that are pushed upward through the other layers of the epidermis toward the stratum corneum, where they flatten, die, and are eventually sloughed off and replaced by new cells. The epidermis is the outermost layer of the skin and the thinnest of the layers. The stratum corneum is made up of flattened dead cells.

Several theorists have identified stages of the grieving process. The nurse understands these stages and knows that people progress through them in an individualized manner. Which statements are true regarding the steps of the grieving process? Select all that apply.

tasks to be achieved at each stage have been identified by each theorist not all individuals will experience all stages of grief

which scenario is hospice provided

terminal illness that requires symptom control

The nurse knows an appropriate goal for a patient with a stage III pressure ulcer with the nursing diagnosis Impaired physical mobility is: a. the patient will remain free of wound infections during the hospitalization. b. the patient will report pain management strategies and reduce pain to a tolerable level. c. the patient will turn self in bed using over trapeze every two hours using assistance when needed. d. the patient will consume adequate nutrition to meet nutritional requirements within 1 week.

the patient will report pain management strategies and reduce pain to a tolerable level. The patient will report pain management strategies to reduce pain to a tolerable level is an appropriate goal for Impaired physical mobility. The patient remaining free of wound infections during the hospitalization is an appropriate goal for Impaired tissue integrity. The patient reporting pain management strategies to reduce pain to a tolerable level is an appropriate goal for Acute pain. The patient consuming adequate nutrition to meet nutritional requirements within 1 week is an appropriate goal for Imbalanced nutrition: less than body requirement.

The nurse understands the rationale for drying a wound after irrigation is: a. to ensure the new dressing adheres to the wound. b. to ensure the new dressing remains occlusive. c. to prevent skin breakdown from moisture. d. to prevent infection from irrigate solution.

to prevent skin breakdown from moisture. Proper drying prevents further skin breakdown from moisture. Patting (rather than rubbing) prevents healthy tissue from being removed and reduces trauma to the wound. The type of dressing will determine how it lays in the wound and whether or not it is occlusive. The drying does not prevent infection.