Chapter 7: Client's Response to Illness
A nurse is caring for a Native American client who has been admitted to the unit for new onset of diabetes mellitus. The client will not agree to any treatments until the local Shaman is present. Which action by the nurse is appropriate in this situation? Explain to the client that confidentiality policies do not allow for a meeting with the client's Shaman. Arrange for the client's Shaman to come to the unit and meet with the client and health care providers. Explain that the Shaman is not a health care provider and cannot be included in treatment discussions. Discuss with the client the right to refuse any medication or treatment.
Arrange for the client's Shaman to come to the unit and meet with the client and health care providers. Explanation: By including the Shaman in treatment discussions, the client will be assured that religious beliefs are important to the healthcare team. The client does have the right to refuse any treatment. However, the nurse should make every effort to resolve the issue so the client can be treated. The Shaman and family can be included in treatment discussions if the client agrees to include them. HIPAA regulations are not violated if the client gives permission for the Shaman to be present for a treatment meeting.
A psychiatric-mental health nurse is working on developing cultural competence. Which would be most appropriate for the nurse to do? Recognize that one's own culture is the predominant way of addressing a client's health care needs. Assume that any individual of a racial or ethnic group is the same as another individual in that group. Research information about the cultures of the population being served after assessing the client. Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs.
Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs. Explanation: Cultural competence requires that a nurse demonstrates a willingness and ability to draw on community-based values, traditions, and customs and that the nurse values clients' cultural beliefs. The nurse needs to demonstrate a genuine interest in, and respect for, the individual and his or her beliefs. The nurse should learn about the client's country of origin and culture before assessing the client. Cultural competence requires the nurse to adjust or recognize his or her own culture in order to understand the client's culture. It also requires the nurse to understand and appreciate the cultural differences and similarities within, among, and between groups. Nurses need to avoid assuming that all individuals of a racial or ethnic group are the same.
An older adult client in the hospital has not had a bowel movement for 3 days and the nurse planned to give the client a stool softener this morning. The client declined the medication, however, stating that the client's spouse will be bringing the client a herbal medication later in the day that is often used by members of their ethnic group. Which reaction demonstrates cultural care accommodation/negotiation? Teaching the client about the benefits of the medication that was ordered for the client Teaching the client about the risks associated with nonstandard doses of herbal remedies Documenting the client's wishes and informing the client's care team what the client will be taking Ensuring that the herbs are sent to the hospital pharmacy for clearance before the client is allowed to take them
Documenting the client's wishes and informing the client's care team what the client will be taking Explanation: In cultural care accommodation/negotiation, the nurse adapts nursing care to accommodate the client's beliefs or negotiate aspects of care that would require the client to change certain practices. Attempting to alter the patient's practice is associated with repatterning/restructuring, and confiscating the herbs is likely not a culturally congruent act, unless they were known to constitute a serious threat to health.
A young adult client who has come to the clinic for evaluation reports feeling anxious lately. During the interview, the client states, "I feel like I still don't know what I should be doing with my life." The nurse interprets this statement as most suggestive of a problem with which developmental task? Identity Autonomy Trust Intimacy
Identity Explanation: A client's age and stage of psychosocial development can influence their response to illness, and a failure to achieve certain developmental tasks can contribute to worse outcomes. A young adult who still expresses serious doubt about "what I should be doing with my life" may have failed to achieve the stage of identify versus role confusion, which is normally navigated in adolescence. A failure to achieve trust (infant stage) would be depicted in statements regarding the inability to develop stable, dependable relationships with others. If the client had not adequately achieved the task of autonomy (preschool), statements would more likely display an overreliance on others. Achievement of intimacy, in which the individual is capable of forming mature, loving relationships, is a developmental goal for the young adult; although it is not yet clear the client will achieve this, the statement is not indicative of a problem with this developmental stage.
A client has come to the mental health center for an initial visit. The nurse has little experience with the client's culture, having cared for only one other client with a similar background. When assessing the new client, which approaches would be best for the nurse to use to provide culturally competent care? Select all that apply. Speak to the client in an informal manner because that is the tone the previous client preferred. Use the new client as the primary source of information. Assume the new client follows beliefs similar to those of the previous client. Demonstrate genuine interest in learning about the new client. Ask the new client about personal beliefs and practices.
Use the new client as the primary source of information. Demonstrate genuine interest in learning about the new client. Ask the new client about personal beliefs and practices. Explanation: To provide culturally competent care, the nurse must find out as much as possible about a client's cultural values, beliefs, and health practices. Typically, the client is the best source for that information, so the nurse must ask the client what is important to him or her. Doing so—and demonstrating genuine interest in the process—shows respect for the client as an individual and increases the likelihood that the client will share the necessary information. At the initial meeting, the nurse must be alert for the client's preferences for greeting, eye contact, and physical distance. Based on the client's behavior, the nurse can decide what approach is best. Variation among members of any cultural group is wide, and the nurse must remain alert for these individual differences. The nurse should never assume that a client follows certain practices or favors certain types of interaction (such as informality in discussions with the nurse) merely because someone else from the same culture did so.
The nurse has been working with a client to develop self-efficacy. What client statement would most likely suggest to the nurse that self-efficacy is improving? "Situations that others find stressful don't really bother me." "I have decided to apply for a promotion at work." "I don't come down with colds anymore when I'm under stress." "I have a group of good friends I can rely on."
"I have decided to apply for a promotion at work." Explanation: Self-efficacy is the belief that one's own actions and abilities impact the events in one's life. Clients with high self-efficacy are more likely to set goals and take actions to achieve those goals. A client who has set a goal of achieving a promotion at work and taken the action to apply for the promotion is demonstrating self-efficacy. The other statements, while positive, don't necessarily depict that trait. For instance, being unaffected physically or emotionally by stressful situations may be indicative of hardiness or resilience; neither statement represents the client taking action. Having a personal network to rely on is helpful, but its existence doesn't suggest self-efficacy unless the client is actively seeking its support in achieving personal goals.
Which statement made by the client demonstrates hardiness when faced with a health issue? "My father was diagnosed with this illness as well." "I know my faith will get me through this illness." "What do I need to do to manage this illness?" "Can you explain what caused this illness?"
"I know my faith will get me through this illness."
During an interview, the nurse is assessing a client for traits that aid in the stress response. What client statement would the nurse recognize as most representative of hardiness? "I am a naturally happy person, so I just don't feel stressed very often." "I perform my best when I am under pressure." "I have always been a person who sets goals to help achieve what I want." "I know some meditation techniques that help me deal with stress."
"I perform my best when I am under pressure." Explanation: The statement most representative of hardiness is "I perform my best when I am under pressure." Individuals with a high degree of hardiness see stressful situations as opportunities and problem-solve more effectively at these times than those with lower hardiness. Setting and working toward goals are signs of high self-efficacy. Being unaffected by stress due to a happy nature is suggestive of resilience. A client who manages stress through meditation or other learned problem-solving techniques is demonstrating resourcefulness.
Which scenario conveys the application of cultural competence in the provision of nursing care? The nurse has independently formed a prayer group on the unit for all clients who are Catholic. An experienced nurse states during a nursing report meeting, "I just don't feel it is appropriate to allow the client to attend Mass when everyone else has to stay here." A new nurse asks a Hispanic colleague to explain how cultural beliefs might influence a Hispanic client's response to health care interventions. The nurse has begun a client teaching group entitled "Understanding Your Medications."
A new nurse asks a Hispanic colleague to explain how cultural beliefs might influence a Hispanic client's response to health care interventions. Explanation: The nurse uses available resources to learn other cultures and incorporate beliefs into quality care. The nurse must engage in the recognition of any negative feelings for stereotypes and discuss them with colleagues in order to dispel myths and misconceptions.
For a client who belongs to an ethnic group that is known to have poor metabolism of psychotropic medications, the nurse should anticipate that the client may be at risk for which problem? Increased drug resistance Decreased therapeutic effect Adverse drug effects Paradoxical drug effects
Adverse drug effects Explanation: People who are poor drug metabolizers have an increased risk of experiencing adverse drug effects by virtue of decreased enzyme activity.
Which approach to care best reflects cultural competence? Always assign nurses of a specific ethnic background to clients with the same ethnic background. Learn all behaviors and values associated with people of specific ethnic backgrounds. Assess the culturally mediated beliefs of each client on an individual basis. Believe that people are more alike than they are different.
Assess the culturally mediated beliefs of each client on an individual basis. Explanation: Culturally competent care means that care is provided in a manner acceptable to the person's cultural background, regardless of whether it is provided by a care provider from the same ethnic or minority group as the client. Health care professionals must be able to incorporate cultural factors, including language, customs, beliefs, and traditions, into plans of care.
A nurse who provides care in a large, city hospital is aware of the large influence of culture on health. The nurse recognizes that culture is best understood as a shared system that encompasses what? Beliefs, values, and behavioral traditions Knowledge, skills, and norms Dress, relationships, and diet Health behaviors, roles, and priorities
Beliefs, values, and behavioral traditions Explanation: Culture is defined in many ways, but at the broadest level, it can be understood to be a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. These beliefs, values, and expectations frequently direct other aspects of an individual's life such as thinking, behavior, dress, and diet, but these are not the central components of the concept of culture.
Which component of hardiness encompasses the ability to make appropriate decisions in life activities? Change Commitment Control Challenge
Control Explanation: Control is the ability to make appropriate decisions in life activities. Commitment is active involvement in life activities. Challenge is the ability to perceive change as beneficial rather than just stressful. Change is not a component of hardiness, according to Kobasa (1979).
A nurse is aware that which of these represents a biochemical variation that may exist between clients of different racial backgrounds? Skin cancer Motor development Drug metabolism Risk for osteoporosis
Drug metabolism Explanation: Drug metabolism differences, lactose intolerance, and malaria-related conditions, such as sickle cell disease, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and Duffy blood group, are considered biochemical variations. Risks for osteoporosis and skin cancer are examples of a ethnic disease variation. Motor development appears to be related to both genetics and environment and is a developmental variation.
In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take? Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief Ask for a dietary consult with an understanding of the "hot and cold food" belief Discuss the possibility of the family providing the appropriate foods Assure the client that these needs will be considered by the staff
Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief Explanation: In cultural care preservation/maintenance, the nurse assists the client in maintaining health practices that are derived from membership in a certain ethnic group. The nurse helps the client select and obtain foods congruent with these beliefs most effectively by educating staff. This is not necessarily possible or even advised if there are medically required food restrictions.
Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance than the client? Explain that physical contact is necessary and ask about the client's cultural personal space preferences. Realize that sitting close to the client is an indication of warmth and caring. Sit 3 to 6 feet away from the client in an attempt to not offend. Remember not to intrude into the personal space of the elderly.
Explain that physical contact is necessary and ask about the client's cultural personal space preferences. Explanation: When providing nursing care that involves physical contact, the nurse should know the client's cultural personal space preferences. Sitting close or too far away from the patient may be interpreted as offensive. Age is not necessarily a deciding factor in regard to a person's cultural practices.
A young adult client who has come to the clinic for evaluation reports feeling anxious lately. During the interview, the client states, "I feel like I still don't know what I should be doing with my life." The nurse interprets this statement as most suggestive of a problem with which developmental task? Identity Autonomy Intimacy Trust
Identity Explanation: A client's age and stage of psychosocial development can influence their response to illness, and a failure to achieve certain developmental tasks can contribute to worse outcomes. A young adult who still expresses serious doubt about "what I should be doing with my life" may have failed to achieve the stage of identify versus role confusion, which is normally navigated in adolescence. A failure to achieve trust (infant stage) would be depicted in statements regarding the inability to develop stable, dependable relationships with others. If the client had not adequately achieved the task of autonomy (preschool), statements would more likely display an overreliance on others. Achievement of intimacy, in which the individual is capable of forming mature, loving relationships, is a developmental goal for the young adult; although it is not yet clear the client will achieve this, the statement is not indicative of a problem with this developmental stage
Why is understanding a client's cultural context important to a psychiatric mental health nurse? It influences the adoption of traditional gender roles. It influences perceptions of health and illness. It helps the care provider avoid offending the client. It helps the care provider choose treatment options.
It influences perceptions of health and illness. Explanation: Culture can influence perceptions of health and illness greatly, as well as how, when, and why people seek treatment for health problems. Culture influences many aspects of psychiatric care, including self-perception; roles and relationships; family dynamics and interactions; attitudes toward medications; values; and community supports. An understanding of the client's cultural context also is necessary to appreciate the client's attitude toward the provider.
The nurse is assessing a client who recently immigrated to the United States. The client is experiencing a high level of stress and reports that nobody in the workplace is willing to work with or talk to the client. What is the most likely cause of stress in the client? Low resilience Low hardiness Low self-efficacy Low sense of belonging
Low sense of belonging Explanation: Sense of belonging is the feeling of connectedness in a social environment. It means that an individual should feel valued and worthwhile in his or her support system. Support system also includes the client's workplace. In this situation, the client does not feel accepted in the workplace and thus the client has a reduced sense of belonging. The particular situation does not indicate that the client has low hardiness, low efficacy, or reduced resilience. Hardiness refers to the ability to resist illness when under stress. Self-efficacy refers to the belief that personal abilities and efforts will affect the events in our lives. A resilient individual exhibits healthy responses in stressful circumstances.
The nurse is assessing a client who recently immigrated to the United States. The client is experiencing a high level of stress and reports that nobody in the workplace is willing to work with or talk to the client. What is the most likely cause of stress in the client? Low self-efficacy Low resilience Low sense of belonging Low hardiness
Low sense of belonging Explanation: Sense of belonging is the feeling of connectedness in a social environment. It means that an individual should feel valued and worthwhile in his or her support system. Support system also includes the client's workplace. In this situation, the client does not feel accepted in the workplace and thus the client has a reduced sense of belonging. The particular situation does not indicate that the client has low hardiness, low efficacy, or reduced resilience. Hardiness refers to the ability to resist illness when under stress. Self-efficacy refers to the belief that personal abilities and efforts will affect the events in our lives. A resilient individual exhibits healthy responses in stressful circumstances.
A Native American client discusses cultural beliefs with the nurse providing care. In order to recognize any negative feelings or stereotypes the nurse has, which should the nurse do to ensure culturally competent nursing care can be provided? Research Native American health care beliefs. Reflect on how the client's beliefs may have similarities and differences from the nurse's own culture. Provide the client with written information on traditional medical principles. Agree to disagree on medical practices and beliefs.
Reflect on how the client's beliefs may have similarities and differences from the nurse's own culture. Explanation: Culturally competent nursing care requires the health care provider to recognize and consider another's viewpoints as a health care provider. While researching Native American health care beliefs is appropriate, this is not the most effective initial intervention that fosters reflection and cooperation. Providing the client with written information reflects an attempt on the nurse's part to change the client's opinion but fails to foster reflection and cooperation. Agreeing to disagree does not encourage reflection or cooperation between the nurse and client.
Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics? Hardiness Tolerance Resilience Social skills
Resilience Explanation: Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.
Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics? Resilience Social skills Hardiness Tolerance
Resilience Explanation: Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.
Which characteristic would be most prevalent in an individual demonstrating low self-efficacy? Self-motivation Stress management Self-doubt Personal goals
Self-doubt Explanation: Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A person who believes that his or her behavior makes a difference is more likely to take action. People with low self-efficacy have low aspirations, experience much self-doubt, and may be plagued by anxiety and depression. People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed.
The nurse caring for several clients on a surgical unit notes that one of the clients the nurse is caring for is Muslim. The nurse, without asking the client, decides to remove all pork from the client's meal tray prior to delivering it to the room. What best describes the nurse's action? Racism Transcultural nursing Stereotyping Honoring rituals
Stereotyping Explanation: While the nurse was trying to be thoughtful (as with transcultural nursing), the action would be considered stereotyping since the nurse assumed this ritual was part of this client's practices. Racism involves negative thoughts or feelings toward a specific group of people.
Which approach to care best reflects cultural competence? Learn all behaviors and values associated with people of specific ethnic backgrounds. Always assign nurses of a specific ethnic background to clients with the same ethnic background. Assess the culturally mediated beliefs of each client on an individual basis. Believe that people are more alike than they are different.
Stress related to career growth Stress related to moving back to parental home Explanation: Most adults in the 25-45 year age range are expected to focus on establishing a career and establishing independence from parents (move out of parental homes). Failure to achieve these developmental tasks may cause stress in this client. Health changes related to aging are evident in middle and old age, thus stress related to these changes may be seen in both middle and old-age adults. Stress related to the inability to look after self is generally noted in older adults who become debilitated and dependent with age. Middle-aged adults focus their attention toward their growing children and aging parents.
All except which problem stem from attitudes in which the focus is on the nurse's beliefs and values rather than those of the client? Viewing a specific client population from a stigmatized view Holding preconceived judgement about cultural groups Developing a general belief system about all people from the same culture Treating the client as a source of cultural information
Treating the client as a source of cultural information Explanation: Treating the client as a source of cultural information aligns with culturally competent nursing care. The nurse conveys that the client has individual preferences and beliefs even if he or she is part of a specific cultural group. Holding a preconceived judgement about cultural groups is consistent with the conveyance of prejudice. The development of general beliefs about all people from the same culture conveys stereotyping. Viewing a specific client population from stigmatized view is promoting stigma or disapproval.
The nurse is caring for a client who was born and educated in southeast Asia. The client moved to the United States two years ago. The client wears Western clothing and eats fast food. Which answer describes what the client has modeled? ethnic mosaic inclusiveness cross culturalism acculturation
acculturation Explanation: Acculturation is the term used to describe the socialization process by which minority groups learn and adopt selective aspects of the dominant culture.
The nurse is trying to effectively deal with the spiritual needs of a client. To best meet the client's need, what should the nurse do? clarify own spiritual values and beliefs before exploring clients' beliefs ask the manager what to do have the healthcare provider deal with spiritual needs have clergy come to see the client
clarify own spiritual values and beliefs before exploring clients' beliefs Explanation: The nurse needs to self reflect and live according to one's own beliefs, and then explore other client's beliefs and values. It does not include having clergy come to see the client, asking the manager what to do, or having the healthcare provider deal with spiritual needs.
The nurse educator is discussing spirituality for nurses in a mental health class. The nurse educator asks a student nurse, "Which of the following is most consistent with spirituality?" The student nurse identifies which description? feeling a connection to a higher power living according to one's beliefs participation in common ways of worshiping closely intertwined with beliefs about health and mental illness
feeling a connection to a higher power Explanation: Spirituality develops over time and is a dynamic, conscious process characterized by two movements of transcendence; either deep within the self or beyond the self. Self-transcendence involves self-reflection and living according to one's values in establishing meaning to events and a purpose to life. Closely intertwined with beliefs about health and mental illness, living according to one's beliefs, and participation in common ways of worshipping are not things that are most consistent with spirituality.
An important part of cultural competence includes the capacity to communicate effectively and convey information that is easily understood. When providing care the nurse should know that cultural competence includes which example? cultivation analysis dramatism negotiation skills linguistic competence
linguistic competence Explanation: Linguistic competence, the capacity to communicate effectively and convey information that is easily understood by diverse audiences and address the health literacy needs of patients and their families, is an important part of cultural competence. Cultivation analysis, negociation skills, and dramatism is not included in examples of cultural competence.
