Cultural/Spiritual

A 62-year-old male patient has just been told he has a terminal illness. Which of the following statements supports a nursing diagnosis of spiritual distress related to diagnosis of terminal illness? 1. "I have nothing to live for now." 2. "What will happen to my wife when I die?" 3. "How much longer do I have to live?" 4. "I need to go to church and pray for a miracle."

1. "I have nothing to live for now." Patients with spiritual distress verbalize lack of hope and meaning.

The nursing student is learning about the different types of families. What could be an example of a blended family? 1. A woman raising her son alone after her husband's death 2. A homosexual couple raising a daughter on their own 3. A woman bringing her adopted son into a new family when she remarries 4. A grandfather taking care of his granddaughter after his daughter's demise

3. A woman bringing her adopted son into a new family when she remarries A blended family is formed when parents bring children who may or may not be biologically related to them into a new, joint-living situation. Hence a woman bringing her adopted son into a new family when she remarries is an example of blended family. A woman raising her son alone after her husband's death is an example of single-parent family. A homosexual couple raising a daughter on their own is an example of an alternative family. A grandfather taking care of his granddaughter after his daughter's demise is also an example of an alternative family.

A patient states, "My religion does not permit me to bathe today." What would be the most appropriate nursing action? 1. Tell the patient that the health care provider has prescribed a bath today. 2. Insist that a bath be taken because it is the patient's scheduled bath day. 3. Call an appropriate clergyperson and ask whether the patient is telling the truth. 4. Request a clarification of the patient's beliefs and adapt a plan for bathing accordingly.

4. Request a clarification of the patient's beliefs and adapt a plan for bathing accordingly. A patient's religious and cultural preferences should be considered when providing hygiene. Facility schedules should not take priority over the patient's religious beliefs, nor should the health care provider's instructions. Verifying the patient's beliefs with clergy is inappropriate.

Which action by a health care facility would demonstrate a commitment to providing culturally competent care? a. Providing continuing education events focused on delivery of linguistic services b. Referral of cultural diverse patients for psychiatric counseling to help them communicate more clearly c. Providing signage in English to help patients and families navigate from one department to the next more easily d. Delegation of all patient and family care to health care professionals that are of the same ethnicity

ANS: A CLAS Standards for Health Care recommend that health care organizations ensure that staff at all levels receive continuing education in linguistically appropriate services. Psychiatric counseling is unnecessary to overcome most communication challenges. Signage needs to be provided in multiple languages commonly spoken in the health care facility in order to better inform and direct patients who do not speak English. It is impossible and unnecessary to delegate all care to persons of like ethnicity.

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

ANS: A Assessing and listening to each patient's customs and beliefs is the most important way to provide culturally congruent and patient-centered care. Collaboration with other professionals is secondary to needs assessment. Treating everyone identically or transferring patients with diverse cultural backgrounds off of the unit does not meet individualized, culturally sensitive standards of care.

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

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

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

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

What response is most appropriate for the nurse if a patient prefers to seek acupuncture for pain relief before taking prescribed medication? a. Recognize that alternative forms of treatment can be effective. b. Require that the patient take the ordered pain medication. c. Refer the patient for professional pain relief counseling. d. Have the patient's family get the patient to take the medication.

ANS: A Many health care professionals and patients recognize the effectiveness of alternative therapies, which are more typically associated with Eastern medicine. Patients should not be forced to take medication against their will. Counseling is unnecessary in this case, and seeking the family's help in convincing the patient to take the prescribed medication is not the best option.

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

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

What action by a nurse would indicate an understanding that foreign-speaking patients experience a clash of more than one culture when admitted to a health care facility? a. Explaining medical terms and verifying that the patient understands b. Sharing written patient information pamphlets for the patient to read c. Orienting the patient's family to the hospital lounge and visiting hours d. Contacting the pharmacy for generic and brand name medications

ANS: A Nurses need to be aware that three cultures intersect in culturally competent care; the nurses and patient's cultures as well as health care culture. Explaining medical terminology and verifying understanding demonstrates an understanding of this phenomena. Sharing pamphlets may not meet patient needs if they are unable to comprehend the written material. Orienting families and calling the pharmacy does not relate to exhibiting cultural competence.

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

ANS: A Storytelling is central to the religion.

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

ANS: A Toddlers need concrete examples of good vs evil to better understand meaning.

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

ANS: A, B, C Susceptibility to illness, body structure, and the presence of a genetic disease are all biological variations that should be assessed during a transcultural assessment according to Giger and Davidhizar. Social orientation and work orientation are not biological phenomena.

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.

ANS: A, B, C The nurse should take into account the patient's body structure and cultural practices when providing care. Use of a professional interpreter is necessary if the nurse and the patient do not speak the same language fluently. Avoid translation of medical information by a patient's family members or friends to ensure privacy and accuracy of essential, personal information.

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

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

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

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

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

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

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

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

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.

ANS: C Many people speak their native language very quickly, which can be confusing to others for whom it is a second language. Slowing down speech helps with articulation and clarity in speaking. Use of acronyms or abbreviations is extremely confusing to individuals who are not native to a language or are just learning it. Speaking more loudly will not help a person understand a foreign language.

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.

ANS: C Recognizing one's own personal biases and cultural norms is essential to providing culturally congruent care according to Leininger and McFarland. When assessing culturally diverse patients, it is essential for the nurse to adapt assessment questions in a manner that is more understandable to the non-English-speaking patient. Nurses should always note the environmental context in which patient interactions take place, consistently documenting the location of assessment. Beliefs and values of family members may vary significantly.

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

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

Immigrants who begin to use technology while continuing to adhere to their traditional mode of dress are exhibiting what aspect of cultural identity? a. Socialization b. Ethnocentrism c. Assimilation d. Acculturation

ANS: D Acculturation occurs when individuals accept some aspects of a new culture without losing their distinct cultural identity. Assimilation involves a total blending of cultures when individuals actually reject or lose much of their original cultural identity. Ethnocentrism is the belief that one's culture is superior to another. Socialization takes place throughout a person's life and involves nurture and a gradual acquisition of cultural characteristics.

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.

ANS: D Assessment of the underlying cause of the body odor is the first step to patient-centered care. Assisting the patient to bathe or asking the patient to bathe may be appropriate interventions once the underlying cause of the body odor is established. Asking family or friends for insight into the source of body odor would be a last step if the patient was unable to provide adequate information and a physical assessment did not reveal the cause.

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

ANS: D Enculturation is the process of passing culture from one generation to the next. Using symbols is one aspect of culture. Challenging traditional values reflects a developmental stage or change in worldview. Supplying basic needs is not dependent on culture.

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

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

6. What aspect of culture is a full-time employed granddaughter of an elderly Asian female exhibiting if she asks the social worker to place her grandmother in an extended-care facility against the wishes of her parents? a. System change b. Gender role c. Cultural norms d. Shared attributes

Answer: a As one aspect of a society changes, the systems within that society change. The granddaughter in this case is employed full time and unable to adequately care for her grandmother at home. Therefore, her request to have the grandmother placed in an extended-care facility is a reflection of societal changes that affect traditional culture expectations of one generation's providing care in the home. Shared attributes, cultural norms, and gender role all are challenged by the granddaughter's actions.

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

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

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

Answer: a Culturally competent care allows for flexibility within safety guidelines and patient care limitations. Allowing a patient to meet with a spiritual advisor recognizes the importance of a patient's spiritual needs. Limiting language use, food consumption, and visiting hours in a strict manner without sensitivity to a patient's preference do not reflect culturally competent nursing

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, white boards, and gestures to communicate all important information. b. Recognize that continuous affirmative answers by the patient require verification of understanding. c. Arrange for a professional language translator to sit with the patient throughout the hospitalization. d. Decrease interaction with the patient and family to avoid making them uncomfortable for not understanding.

Answer: b Consistent affirmative answers from a patient in the form of verbal responses of nods may indicate that a patient does not really understand what is being asked and is just trying to be cooperative. It is important for the nurse to double check to make sure a patient understands instructions and questions to ensure safety and proper care. Not all information can be conveyed via pictures or gestures, and professional interpreters typically are not used as patient sitters. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.

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.

Answer: b Decisions about whether a patient has met treatment goals or outcomes should be based on patient feedback and a nurse's professional judgment. Gender role considerations are unlikely to play a role in evaluation. Future community care providers are unable to help in the evaluation of patient goals before participating in a patient's care. The patient is the primary person from whom information should be obtained in evaluating goals and outcomes.

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. Sharing with unlicensed assistive personnel that typically Muslim patients do not eat pork c. Telling the radiology technician that every Latino family is late for appointments d. Assuming that Asians share financial responsibility for medical bills

Answer: b Muslims typically do not consume pork products. This generalization would be helpful to use as a baseline for caring for Muslim patients. It is always important, however, for nurses to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements that are unkind regarding people of one culture is stereotyping and hurtful. The Amish, not Asians, typically share responsibility for medical

9. Which nursing diagnosis is most appropriate for a young Middle Eastern immigrant who expresses concern for the safety of his family members who were unable to relocate with him out of a war zone? a. Risk for Spiritual Distress b. Impaired Role Performance c. Interrupted Family Processes d. Ineffective Coping

Answer: c A key-related factor in interruption of family processes is a situational crisis that causes a change in communication and emotional and mutual support, which all are present in this case. None of the information provided indicates a spiritual crisis, ineffectiveness of coping, or impairment of role performance.

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

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

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.

Answer: c Ethnicity is based on cultural similarities and differences in a society or nation. The similarities are with members of the same ethnic group; the differences are between that group and others. Ethnicity is not based on or determined by genetics or skin color. Culture, ethnicity, and socialization are all related concepts.

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

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

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

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

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

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

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

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

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

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

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

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

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.

Answer: d The best way to provide for a patient's dietary needs is to ask the patient for personal preferences, limitations, allergies, and typical dietary intake. Preordering, checking with a co-worker, or ordering a variety of options without input from the patient first does not reflect patient-centered care.

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

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

4. Which of the following questions is/are appropriate to ask during a transcultural assessment? (Select all that apply.) a. How do you act when you are angry? b. What is your role in your extended family? c. Why do you continue to speak German at home? d. When communicating with friends, how close do you stand? e. What is the purpose of not preparing beef with milk products?

Answers: a, b, d How a person acts when angry, the person's role in the family, and comfort with proximity all are relevant aspects of the patient's cultural norms, according to Giger and Davidhizar, and should be assessed to raise the nurse's awareness of patient needs. Asking a patient why they use their native language in the home is unnecessary. If primary language information is needed, the nurse should simply ask what language is spoken in the home. The nurse should not try to seek information about the reason a person maintains dietary traditions during the assessment process.

3. Which statement(s) reflect/s the practice of transcultural nursing? (Select all that apply.) a. May be considered a general and specialty practice area b. Focuses on the world view rather than patient needs c. Challenges traditional ethnocentric nursing practice d. Aims to identify individual patient care preferences e. Focuses patient care on the nurse's cultural norms

Answers: a, c, d Transcultural nursing is a general and specialty practice that focuses on both world view and individual patient and family needs for planning and providing care. It challenges nurses to investigate other cultures in order to reject ethnocentric care and respond to individual needs.

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

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

Which actions does the nurse take to become culturally competent? Select all that apply. A. Consider patient's preferences when developing care plans B. Overcome cultural prejudices, biases, and personal beliefs C. Recognize personal attitudes toward patients from other cultures D. Improve professional cross-cultural communication skills E. Understand why Western medicine is superior to alternative therapies

Correct A, B, C, D Cultural competence involves understanding and including a patient's cultural health care practices when planning care for the patient. The nurse needs to improve cross-cultural communication skills to understand the patient's use of certain words that are culture-specific. The nurse should overcome any cultural prejudices and biases, as it will help to plan care according to the patient's preference. The nurse should recognize his or her own attitude towards patients from other cultures, as it helps to prevent prejudicial thinking. The nurse considers patient preferences while developing care plans, as the patient may think that certain health practices are beneficial. The nurse should not incorporate ethnocentricity (Western medicine is superior) into care because it devalues the patient's health care practices.

The nurse is assessing culture. What are the basic elements of culture? Select all that apply. A. Shared B. Learned C. Symbolic D. Biological E. Integrated

Correct A, B, C, E Culture has four 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.

A nurse is caring for a 50-year-old Hindu Asian male patient who is hospitalized following an incidence of high blood pressure. After reviewing the patients' data, the nurse plans a diet that takes into consideration his culture. Which actions are required when developing a diet plan? Select all that apply. A. Provide one diet for all patients. B. Provide culturally sensitive teaching brochures. C. Refer the patient to a dietitian who is familiar with his food choices. D. Develop a diet plan that includes the patients' cultural diet preferences. E. Ask the patient to adapt to a generic diet plan.

Correct B, C, D The patient's food practices may stem from his religious and cultural beliefs and ethnicity, so the nurse should properly assess these factors when preparing a diet plan. The nurse should provide culturally sensitive brochures that describe healthy food choices and refer the patient to a dietitian familiar with his food choices. The nurse should also develop a diet plan that accommodates the patient's cultural diet preferences. There are no standard food habits applicable to each patient, so one diet does not fit everyone. The patient should not be asked to adapt to a diet plan if it contradicts the diet he prefers because of his background.

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

Correct B, C, E 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.

The nurse is caring for an elderly patient undergoing dialysis. The patient's spouse died of a heart attack a week ago. Which statement made by the patient indicates spiritual distress? 1. "All my prayers and good deeds were in vain." 2. "I will have to move to an assisted living facility." 3. "Can you arrange a meeting with the chaplain?" 4. "I wish we could have spent more time together."

Correct 1. "All my prayers and good deeds were in vain." The patient is going through a phase of disturbed faith and lacks confidence in his or her prayers and good deeds. This indicates that the patient is experiencing spiritual distress. When the patient is thinking about moving to an assisted living facility, the patient is trying to find practical solutions to meet health care needs. If the patient seeks a meeting with the chaplain, the patient is trying to reconcile with self and overcome grief. The patient expresses sadness, not spiritual distress, at being unable to spend more time with the spouse.

After speaking to a patient with depression, the nurse observes that the patient is experiencing discrimination. Which statement made by the patient helped the nurse to arrive at this conclusion? 1. "My boss fired me when I admitted that I'm gay." 2. "My friends have stopped talking to me for at least a year." 3. "My neighbors seem to dislike me for no apparent reason." 4. "My parents rarely call me or express any wish to see me."

Correct 1. "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 patient may perceive that the neighbors are rude or do not like the patient; however, there is no evidence that it is true. If the parents do not call or see the patient, it indicates family issues that need further assessment. The friends may have stopped talking to the patient due to some disagreement or other social issues; however, it does not indicate that the patient is experiencing discrimination.

The nurse is caring for a critically ill infant. Which is the best intervention by the nurse to help the mother to bond with the dying infant? 1. Allow the mother to hold the infant and pray. 2. Help the mother to read from a spiritual text. 3. Pray for the infant as well as with the mother. 4. Arrange for the chaplain to pray with the mother.

Correct 1. Allow the mother to hold the infant and pray. The nurse must remove environmental barriers and allow the mother to hold the infant while praying. The nurse may pray with the mother, read passages from a spiritual book, or arrange for the chaplain to pray with the mother as a means of providing spiritual care. However, these are not nursing interventions that promote mother-infant bonding.

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

Correct 1. 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.

A nurse develops a nursing diagnosis for a patient. Which factor can cause a culturally insensitive diagnosis? 1. Cultural bias 2. Medical history 3. Generalization 4. Cultural care repatterning

Correct 1. 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 correct reason for the patient's behavior. The patient's medical history will help in formulating an accurate nursing diagnosis, as it helps to understand the patient's current condition. Cultural care repatterning respects the patient's cultural values while helping them to adopt new and different health care patterns for a healthier life. Generalizing will not adversely affect the nursing diagnosis; it helps to anticipate and understand patient behaviors

A patient is diagnosed with end-stage renal disease. The patient tells the nurse, "I know I am going to be all right, and I will be healthy again. I believe in God, and He will make things right. My spouse and I are yet to tour the world." What kind of spiritual belief does this patient exhibit? 1. Hope 2. Self-transcendence 3. Transcendence 4. Agnosticism

Correct 1. Hope Hope is a belief that something positive is going to happen. It exists where faith and spirituality are present. Hope is comforting and energizing to people facing extreme emotional and physical distress, hardships, and personal challenges. It is a valuable resource motivating a person to achieve. Self-transcendence is a feeling and a sense of connecting to one's inner self. Transcendence is a feeling or experience beyond normal and above the material world. Agnosticism is a belief that there is no known ultimate reality.

The nurse is caring for a patient receiving chemotherapy for cancer. The patient does not complain despite the challenges faced. The patient is looking forward to a positive outcome. What term should the nurse use to define this attitude? 1. Hope 2. Faith 3. Spirituality 4. Transcendence

Correct 1. Hope Hope is when a person has a confident expectation of a positive outcome when they are in challenging situations. Faith is a belief that is based on trust and life experience, rather than scientific data. Spirituality is an expression of one's innermost self that helps an individual grow throughout life. Spirituality requires faith, and when a person has faith, the individual is more likely to demonstrate hope. Transcendence is the process of moving beyond the present state of life to what one expects to become in the future.

Which assessment finding is a symbolic aspect of culture for a patient? 1. Language 2. Occupation 3. Infrastructure 4. Gender roles

Correct 1. 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 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? Correct 1. The nurse lacks cultural competence. 2. The nurse is providing medical information. 3. The nurse is prejudiced against the patient. 4. The nurse demonstrates evidence-based practice.

Correct 1. 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 using evidence-based practice in this case, as the nurse demonstrates incomplete knowledge about folk medicine. 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 caring for a patient who follows the Hindu religion and holds karma responsible for the illness. What is karma? 1. The result of past behaviors 2. The cycle of birth and rebirth 3. The individual's moral conduct 4. The path of liberation to harmony

Correct 1. The result of past behaviors According to Hinduism, karma is a consequence of past behaviors. Samara is reincarnation, or the cycle of birth and rebirth. Dharma is the moral conduct of an individual. Moksha is the path of liberation toward harmony, and it occurs through reincarnation

A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: 1. Chose to be bicultural. 2. Adapted to and adopted the American culture. 3. Had an extremely negative experience with the American culture. 4. Gave up part of her ethnic identity in favor of the American culture.

Correct 2. Adapted to and adopted the American culture. Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture.

A 4-year-old African child is adopted by an American couple. This child slowly adapts to American society. What is this process known as? 1. Biculturism 2. Assimilation 3. Enculturation 4. Ethnocentrism

Correct 2. Assimilation Assimilation is a process in which people belonging to a minority culture adopt the culture of the dominant group. In this scenario the child slowly adapts to the new American identity. Biculturism is when a person belongs to two cultures. Enculturation is when an individual socializes in his or her own culture. Ethnocentrism is the belief that one's culture is superior to others.

A patient states that he does not believe in the existence of God. This patient most likely is an: 1. Academic 2. Atheist 3. Agnostic 4. Anarchist

Correct 2. Atheist Atheists do not believe in the existence of God.

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 to best understand the patient's condition? 1. Gender role 2. Health care practices 3. History of alcohol abuse 4. Communication patterns

Correct 2. 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 leave bruises on the skin. The patient's gender role will not help to understand the cause of bruises on the patient's back. Assessment of a history of alcohol abuse is not relevant to the patient's condition in this case. Understanding the patient's communication patterns will not help to understand the cause of the bruises.

An emergency department nurse is caring for a patient who was severely injured in a car accident. The patient's family is in the waiting room. They are crying softly. The nurse sits down next to the family, takes the mother's hand, and says, "I can only imagine how you're feeling. What can I do to help you feel more at peace right now?" In this example the nurse is demonstrating: 1. Prayer 2. Presence 3. Coaching 4. Instilling hope

Correct 2. Presence The nurse demonstrates presence in this situation by establishing a therapeutic relationship and being with the mother during a particularly stressful time.

The nurse is caring for a patient who claims to be an agnostic. What should the nurse understand about the patient's spiritual belief? 1. That there is not one but many gods 2. That existence of a God is not known 3. That God has established a covenant 4. That God or higher powers do not exist

Correct 2. That existence of a God is not known An agnostic believes that the nature or existence of God cannot be known. An agnostic neither believes nor claims to disbelieve in God. Individuals who practice Hinduism believe in the concept of many gods, who are different aspects of one God. An atheist does not believe that any higher power exists. Individuals who practice Judaism believe that God established a covenant with the Jews.

The nurse includes pork in the diet of a patient of Middle Eastern descent. The patient is offended and informs the nurse that the pork will not be eaten. Which statement explains the nurse's behavior? 1. The nurse lacks appropriate communication skills. 2. The nurse has failed to plan culturally congruent care. 3. The nurse is prejudiced against the patient's culture. 4. The nurse has exhibited racist behavior during the interaction.

Correct 2. 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.

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? 1. "Some alternative therapies might prove useful for your condition." 2. "The primary health care provider may prescribe a Western therapy." 3. "Alternative therapies are not as useful as current Western therapies." 4. "There can be some side effects when using alternative therapies."

Correct 3. "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. Informing the patient that the primary health care provider may prescribe a Western therapy does not indicate ethnocentrism because the nurse is only informing the patient about the treatment options. Saying that some alternative therapies are useful demonstrates the nurse's cultural sensitivity. Informing the patient about the side effects of alternative therapies indicates that the nurse is helping the patient to make an informed decision.

Which patient demonstrates acculturation? 1. An Indian mother who asks her child to touch an elder's feet to receive blessings. 2. A Latino patient who expresses suspicion and disapproval of Western treatments. 3. A Korean student in the U.S. who observes both Thanksgiving and traditional ancestral spirituality. 4. A Senegalese immigrant to the U.S. who speaks fluent English and has abandoned traditional medicine.

Correct 3. A Korean student in the U.S. 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. A West African 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. Expressing disapproval of Western treatments indicates a patient's inability to accept the health practices of another culture.

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

Correct 3. Allow the patient to pray and come back later to administer the medication The nurse should respect the patient's religious beliefs. Muslims offer namaz or prayers at specific times of the day. The nurse should let the patient complete his 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 his prayer, because his culture dictates that he pray at specific times. The nurse should not express to the patient that she has other patients.

Which culture-specific health practice is likely to be seen in a patient of Latino descent? 1. Refusal to get psychiatric care due to the stigma 2. Considering illness as a result of disharmony in their life 3. Classification of treatments as hot or cold therapies 4. Preference for current Western health care practices

Correct 3. Classification of treatments as hot or cold therapies Many Latino patients categorize treatments as hot and cold therapies. They believe that "hot" disorders like hypertension should be treated with "cold" therapies like passionflower tea. They often prefer traditional healing practices due to a mistrust of Western medicines. Many African-American patients believe that illness occurs due to disharmony in life. Many Asian patients refuse to seek psychiatric care due to the social stigma.

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? 1. Biculturism 2. Assimiliation 3. Enculturation 4. Acculturation

Correct 3. Enculturation Enculturation is a process by which an individual socializes in his or her own culture. Biculturism is when a person follows two cultures. Assimilation is when a member of a minority culture takes on the culture of the dominant group. Acculturation is when an individual takes on the culture of a different group.

A family consists of a man, his parents, his wife, and their two sons. This is an example of which kind of family? 1. Nuclear family 2. Blended family 3. Extended family 4. Alternative family

Correct 3. Extended family An extended family includes the nuclear family plus relatives. A nuclear family consists of the husband, the wife, and their children. A blended family is formed when parents bring children from previous relationships into a new joint living setting. An alternative family can be a skip-generation household, multiadult household, or household led by a homosexual couple.

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. This is an example of a(n): 1. Illness attributed to natural and biological forces. 2. Creation of the student's interpretation and descriptions of the data. 3. Influence of socioeconomic factors in morbidity and mortality. 4. Combination of naturalistic, religious, and supernatural modalities.

Correct 3. 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.

A Catholic patient with diabetes receives the following items on his meal tray on the Friday before Easter. For which of the foods does the nurse offer to substitute? 1. Apple sauce 2. Cheese and crackers 3. Spaghetti with meat sauce 4. Tossed salad with ranch dressing

Correct 3. Spaghetti with meat sauce Most Catholics do not eat meat on Good Friday.

A Muslim patient is scheduled for transplant surgery. The patient asks the nurse to postpone the operation for an hour so that the evening prayers can be completed before the operation. How should the nurse respond to such a request? 1. Ask the patient to finish his prayers early. 2. Offer to pray on his behalf so the operation is on time. 3. Ask the family to persuade the patient to be on time for surgery. 4. Agree to the patient's request and postpone surgery.

Correct 4. Agree to the patient's request and postpone surgery. The nurse should allow time for the patient's religious rituals, prayers, spiritual visitations, and attendance in religious services. These are integral parts of the patient's spiritual well-being. Followers of Islam have specific timing for prayers and should not be asked to pray early. The nurse may offer to pray with the patient but not on his behalf, as the nurse may not know the prayer ceremonies the patient prefers. The nurse should not ask the family to persuade the patient to be on time for the operation if that means he misses his prayer time

To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own: 1. Motivation and commitment to caring. 2. Social, cultural, and biophysical factors. 3. Engagement in cross-cultural interactions. 4. Background, recognizing personal biases and prejudices.

Correct 4. 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.

The nurse is providing care for a patient with hypertension who is of Latino origin. The nurse belongs to a culture that believes in consumption of hot juices and foods for hypertension. However, the nurse includes cold juices in the patient's diet plan. Which trait does the nurse demonstrate in this case? 1. Racism 2. Stereotyping 3. Prejudicial thinking 4. Cultural competence

Correct 4. Cultural competence Latinos consider hypertension a hot disorder that would be treated with cold therapies. The nurse has planned the patient's diet considering the cultural preferences, demonstrating cultural competence in this case. Stereotyping involves having fixed negative ideas about patients who belong to a definite cultural group. Prejudicial thinking refers to the process of devaluing an entire cultural group due to assumed attributes. Racism refers to the act of attributing superiority to a patient or person based on the person's race.

Which behavioral characteristic of a patient indicates hopelessness? 1. Demanding extra attention 2. Seeking alternative care activities 3. Complaining about the treatment plan 4. Failing to follow medical recommendations

Correct 4. Failing to follow medical recommendations Hopeless individuals tend to be passive and uninterested in seeking care or following through with recommendations. They feel that none of the interventions would be beneficial in treating their condition. Therefore, they do not often complain or draw attention to themselves by demanding attention or seeking other care.

A patient is scheduled for a chemotherapy treatment and asks the nurse to pray. What is the best intervention by a nurse who is not accustomed to praying? 1. Ask the family members to pray with the patient instead of the nurse. 2. Ask if there is anything else that can be done for the patient at this time. 3. Arrange for the chaplain to pray with the patient since the nurse is busy. 4. Maintain a respectful silence and allow the patient to lead all the prayers.

Correct 4. Maintain a respectful silence and allow the patient to lead all the prayers. The best intervention in this situation would be to maintain respectful silence and allow the patient to lead the prayer. This provides comfort for the patient and fosters trust in the nurse. The nurse may arrange for the chaplain or family members to join in the prayer; however, the nurse's presence is required. The nurse should not evade the situation by making an excuse.