Psych Quiz 2 Chpt 5,8,9
Things not to do with a pt
-argue -give false reassurance -Question or probe about sensitive subjects -Try to sell the pt on accepting treatment -participate in criticism
A term is a synonym for the characteristic of genuineness? Respect Positive regard Empathy Authentic
Authentic
Culture
Beliefs, customs, and traditions of a specific group of people.
The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? Decreased client communication Lessening of client emotional pain Increased hope for client improvement Enhanced client coping
Decreased client communication
Race
Defined biologically, anthropology, and genetics
In the Chinese tradition, disease is believed to be caused by what factor? Fluctuations in opposing forces Adoption of Western beliefs Members' disobedience Outside influences
Fluctuations in opposing forces
A recent immigrant to the United States from which country would tend to display little facial emotion when dealing with emotional stress? Japan Korea Mexico Germany
Germany
What term is used to describe a deviation from expectations by members of the cultural group? Illness Hostility Lack of self-will Variation from tradition
Illness
Countertransference
Nurse displaces her past feelings onto pt ( unconsciusly/ inappropriately)
A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? Positive transference Congruence Empathetic feelings Countertransference
Positive transference
During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? Clarifying and suggesting collaboration Reflecting and exploring Presenting reality and encouraging planning Giving information and encouraging evaluation
Reflecting and exploring
A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure? Feeling personally inadequate regarding dependability Traditional belief that failure may result in a changed fate Shaming the family by being responsible for the error The inability to achieve her personal goals in the workplace
Shaming the family by being responsible for the error
Ethnicity
Shares a common heritage/ history
Minority Status
Subset of people who think of themselves and are thought of by others as a differentiated group
Termination phase
Summarize goals/ objectives; review previous phases and end relationship
The preferred seating arrangement for a nurse-client interview should incorporate which positioning? The client sitting in a chair and the nurse standing a few feet away The nurse and client sitting at a 90-degree angle to each other The nurse behind a desk and the client in a chair in front of the desk The nurse and client sitting facing each other
The nurse and client sitting at a 90-degree angle to each other
A 55-year-old client recently came to the United States from England on a work visa. The client was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the client shows little emotion. Which of the following explanations is most plausible for this lack of emotion? The response may reflect cultural norms. The response may reflect personal guilt. The client may have an antisocial personality. The client in denial.
The response may reflect cultural norms.
When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? Preorientation phenomenon Autonomous interaction Therapeutic encounter Crisis intervention
Therapeutic encounter
The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? The nurse is a new friend They view the nurse as a peer They view the nurse as a stranger The nurse is a safe person to interact with
They view the nurse as a stranger
A black patient says to a white nurse, "There's no sense talking about how I feel. You wouldn't understand because you live in a white world." The nurse's best action would be to a. explain, "Yes, I do understand. Everyone goes through the same experiences." b. say, "Please give an example of something you think I wouldn't understand." c. reassure the patient that nurses interact with people from all cultures. d. change the subject to one that is less emotionally disturbing.
b. say, "Please give an example of something you think I wouldn't understand."
A nurse wants to engage an interpreter for a severely anxious 21-year-old male who immigrated to the United States 2 years ago. Of the four interpreters below who are available and fluent in the patient's language, which one should the nurse call? a. 65-year-old female professional interpreter b. 24-year-old male professional interpreter c. A member of the patient's family d. The patient's best friend
b. 24-year-old male professional interpreter
A Native American patient describes a difficult childhood and dropping out of high school. The patient abused alcohol as a teenager to escape feelings of isolation but stopped 10 years ago. The patient now says, "I feel stupid. I've never had a good job. I don't help my people." Which nursing diagnosis applies? a. Risk for other-directed violence b. Chronic low self-esteem c. Deficient knowledge d. Social isolation
b. Chronic low self-esteem
A nurse cares for a first-generation American whose family emigrated from Germany. Which worldview about the source of knowledge would this patient likely have? a. Knowledge is acquired through use of affective or feeling senses. b. Science is the foundation of knowledge and proves something exists. c. Knowledge develops by striving for transcendence of the mind and body. d. Knowledge evolves from an individual's relationship with a supreme being.
b. Science is the foundation of knowledge and proves something exists.
Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. A nurse is responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said was understood.
c. Silence can provide meaningful moments for reflection.
Why is the study of culture so important for psychiatric nurses in the United States? (Select all that apply.) a. Psychiatric nurses often practice in other countries. b. Psychiatric nurses must advocate for the traditions of the Western culture. c. Cultural competence helps protect patients from prejudice and discrimination. d. Patients should receive information about their illness and treatment in terms they understand. e. Psychiatric nurses often interface with patients and their significant others over a long period of time.
c. Cultural competence helps protect patients from prejudice and discrimination. d. Patients should receive information about their illness and treatment in terms they understand. e. Psychiatric nurses often interface with patients and their significant others over a long period of time.
A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient, who was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best explains this behavior? a. The patient wants to lead the group and give directions to others. b. The patient wants to secure a chair that will be close to the group leader. c. The military culture values timeliness. The patient does not want to be late. d. The behavior indicates feelings of self-importance that the patient wants others to appreciate.
c. The military culture values timeliness. The patient does not want to be late.
A patient who has been hospitalized for 3 days with a serious mental illness says, "I've got to get out of here and back to my job. I get 60 to 80 messages a day, and I'm getting behind on my email correspondence." What is this patient's perspective about health and illness? a. Fateful, magical b. Eastern, holistic c. Western, biomedical d. Harmonious, religious
c. Western, biomedical
What is the primary difference between a social and a therapeutic relationship? Type of information Amount of emotion invested Amount of satisfaction felt Type of responsibility involved
Type of responsibility involved
What therapeutic communication technique is the nurse using by asking a newly admitted client, "Can you tell me what was happening to you that led to your being hospitalized here?" Using an open-ended question Paraphrasing Reflecting Using a minimal encourager
Using an open-ended question
A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response should the nurse use to clarify the patient's comment? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So you feel as though you did not get enough quality sleep last night?" d. "Can you give me an example of what you mean by 'stoned'?"
d. "Can you give me an example of what you mean by 'stoned'?"
4. A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "I hope you will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me."
d. "I'd like to sit with you for a while to help you get comfortable talking to me."
During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. "Why do you keep asking about me?" b. "Nurses direct the interviews with patients." c. "Do not ask questions about my personal life." d. "The time we spend together is to discuss your concerns."
d. "The time we spend together is to discuss your concerns."
Which technique will best communicate to a patient that the nurse is interested in listening? a. Restating a feeling or thought the patient has expressed. b. Asking a direct question, such as "Did you feel angry?" c. Making a judgment about the patient's problem. d. Saying, "I understand what you're saying."
a. Restating a feeling or thought the patient has expressed.
A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy.
a. is rarely helpful.
A Chinese American patient diagnosed with an anxiety disorder says, "My problems began when my energy became imbalanced." The nurse asks for the patient's ideas about how to treat the imbalance. Which comment would the nurse expect from this patient? a. "My family will bring special foods to help me get well." b. "I hope my health care provider will prescribe some medication to help me." c. "I think I would benefit from talking to other patients with a similar problem." d. "I would like to have a native healer perform a ceremony to balance my energy."
a. "My family will bring special foods to help me get well."
An experienced psychiatric nurse plans to begin a new job in a community-based medication clinic. The clinic sees culturally diverse patients. Which action should the nurse take first to prepare for this position? a. Investigate cultural differences in patients' responses to psychotropic medications. b. Contact the clinical nurse specialist for guidelines regarding cultural competence. c. Examine the literature on various health beliefs of members of diverse cultures. d. Complete an online continuing education offering about psychopharmacology.
a. Investigate cultural differences in patients' responses to psychotropic medications.
The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics? a. Patients of different cultural groups may metabolize medications at different rates. b. Metabolism of psychotropic medication is consistent among various cultural groups. c. Differences in hepatic enzymes will influence the rate of elimination of psychotropic medications. d. It is important to provide patients with oral and written literature about their psychotropic medications.
a. Patients of different cultural groups may metabolize medications at different rates.
A nurse prepares to teach important medication information to a patient of Mexican heritage. How should the nurse manage the teaching environment? a. Stand very close to the patient while teaching. b. Maintain direct eye contact with the patient while teaching. c. Maintain a neutral emotional tone during the teaching session. d. Sit 4 feet or more from the patient during the teaching sessio
a. Stand very close to the patient while teaching.
Which viewpoint of an Asian American family will most affect decision making about care? a. The father is the authority figure. b. The mother is head of the household. c. Women should make their own decisions. d. Emotional communication styles are desirable.
a. The father is the authority figure.
The sibling of an Asian American patient tells the nurse, "My sister needs help for pain. She cries from the hurt." Which understanding by the nurse will contribute to culturally competent care for this patient? Persons of an Asian American heritage a. often express emotional distress with physical symptoms. b. will probably respond best to a therapist who is impersonal. c. will require prolonged treatment to stabilize these symptoms. d. should be given direct information about the diagnosis and prognosis.
a. often express emotional distress with physical symptoms.
A nurse speaks with family members of a Chinese American parent recently diagnosed with major depressive disorder. Which comment by the nurse will the family find most comforting? "The nursing staff will a. take good care of your parent." b. pray with your parent several times a day." c. teach your parent important self-care strategies." d. educate your parent about safety information regarding medication."
a. take good care of your parent."
Transference
pt displays feelings onto a nurse can be positive/negative
orientation phase
when the nurse and the patient meet and get to know each other, establish support, goals are set, terms of meetings, explain confidentiality
What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? "School is stressful. What do you find most stressful?" "I know just what you are going through. The stress is terrible." "Don't let them beat you! Fight back!" "You have only two more semesters. You will be glad if you stick it out."
"School is stressful. What do you find most stressful?"
Of the following environments, which would be most conducive to a therapeutic session? A quiet section of the day room The utility room The nurses' station A table in the coffee shop
A quiet section of the day room
During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? Allow the client to break the silence Quickly break the silence and encourage the client to continue Reassure the client that the abuse was not her fault Reach out and gently touch the client's arm
Allow the client to break the silence
When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" Reflection Focusing Clarification Restating
Clarification
After a client discusses a personal relationship with a parent, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by this person?" What is the purpose of the nurse's question? Verbalizing the implied Eliciting more information Clarifying the message Encouraging evaluation
Clarifying the message
Working
Indentify/ explore problems areas of pt
Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? Working phase Termination phase Orientation phase Preorientation phase
Termination phase
A Vietnamese patient's family reports that the patient has wind illness. Which menu selection will be most helpful for this patient? a. Iced tea b. Ice cream c. Warm broth d. Gelatin dessert
c. Warm broth
A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine a. if the patient's immunizations are current. b. the patient's religious preferences. c. the patient's specific ethnic group. d. whether an interpreter is needed.
d. whether an interpreter is needed.
Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? "What sorts of stress are you presently experiencing?" "What usually helps people who have the same type of illness you have?" "What questions would you like to ask about your condition?" "Is there someone in your community who usually cures your illness?"
"What usually helps people who have the same type of illness you have?"
A client is presenting with behaviors that indicate anger. When approached, the client states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the client? "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" "I don't believe you. You are not being truthful with me." "Okay, but we are all here to help you, so come get one of the staff if you need to talk."
"It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"
A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter." "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge."
"My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"
Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? "So, ethnicity refers to having the same life goals whereas culture refers to race." "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values. "So, ethnicity refers to race, and culture refers to having the same worldview." "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes."
"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values.
A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which response by the nurse illustrates empathy? "That must have been such a hard situation for you to deal with." "You need to focus on yourself right now. You deserve to take time just for you." "I know that you will get over this. It just takes time." "I'm so sorry. My father died 2 years ago, so I know how you are feeling."
"That must have been such a hard situation for you to deal with."
Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? "Where can I find information on the concept of Yin-Yang?" "How can I explain why we can't provide for his request for acupuncture?" "How do I go about arranging for a Chinese translator?" "What can I do to provide ethnic foods that are still low in fat?"
"What can I do to provide ethnic foods that are still low in fat?"
A client has been admitted to an inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which response reflects a helpful trait in a therapeutic relationship? "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." "It's good that you feel guilty. That means you still have a chance of being helped." "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."
"You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."
Nurse Behaviors Indicating Boundary Crossing
-Spending long periods of time with the patient, more than is necessary or is comparable to time spent with other patients. -Doing tasks for the patient that could be done independently. -Sharing too much information w / the pt. -Thinking about the pt outside of the care setting -Being defensive when others comment on the special attention the pt is receiving. -Accepting personal comments and questions made by the patient
Goals of Nurse/ pt relationship
-education -promote independence -advocate -better the outcome for pt's
Things to do with a pt
-keep focus -listen -pay attention to non verbal communication -Encourage pt to look at pros/cons -focus on facts and the patients perceptions
Which nursing behavior best demonstrates the concept of cultural competence? Educating clients about the cultural norms of the United States Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices Engaging in continuing education classes on culture in the process of becoming culturally competent Acquiring knowledge about different cultures
Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices
When a client states "That nurse never seems comfortable being with me." How is the client characterizing the nurse? As transmitting fear of clients. As being controlling As being unfriendly and aloof As not seeming genuine to the client
As not seeming genuine to the client
The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? Covert anger Boundary blurring Empathy Value dissonance
Boundary blurring
During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? One statement may simultaneously convey conflicting messages Many of the client's remarks are no more than social phrases Content of messages may be contradicted by process The mental image of a word may not be the same for both nurse and client
Content of messages may be contradicted by process
What term is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices? -Cultural encounters -Enculturation. -Ethnocentrism -Acculturation.
Enculturation.
Which statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.) In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable
In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient.
During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? Preorientation Orientation Working Termination
Orientation
According to the Western scientific view of health, what causes illness? Energy blockage Soul loss Pathogens Spirit invasion
Pathogens
When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with their knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? The client is responding to the voices by ending the conversation. The nurse failed to explain the purpose of the admission interview. The nurse violated the client's personal space by physically being too close. The client has issues with sharing personal information.
The nurse violated the client's personal space by physically being too close.
What is the focus during clinical supervision? Devising alternative strategies for client growth Assisting the client to develop increased independence The nurse's behavior in the nurse-client relationship Analysis of the client's motivation for transferences
The nurse's behavior in the nurse-client relationship
8. Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate? a. The patient is giving positive feedback about the nurse's communication techniques. b. The nurse is viewing the patient's behavior through a cultural filter. c. The patient's verbal and nonverbal messages are incongruent. d. The patient is demonstrating psychotic behaviors.
The patient's verbal and nonverbal messages are incongruent.
Which idea held by the nurse would best promote the provision of culturally competent care? Western biomedicine is one of several established healing systems. Need for spiritual healing is a concept that crosses cultural boundaries. Some individuals will profit from use of both Western and folk healing practices. Use of cultural translators will provide valuable information into health-seeking behaviors.
Western biomedicine is one of several established healing systems.
When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects which cultural concept? Yin-Yang Negative forces Inheritance Supernatural causes
Yin-Yang
A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is most therapeutic? a. "Let's talk about something other than the CIA." b. "It sounds like you're concerned about your privacy." c. "The CIA is prohibited from operating in health care facilities." d. "You have lost touch with reality, which is a symptom of your illness
b. "It sounds like you're concerned about your privacy."
Which statement best explains the term "worldview"? -Valuing one's beliefs and customs over those of another group -Ideas derived from the major health care system of the culture about what causes illness -Cultural norms about how, when, and to whom illness symptoms may be displayed -Beliefs and values held by people of a given culture about what is good, right, and normal
Beliefs and values held by people of a given culture about what is good, right, and normal
The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.) Facilitating communication of distressing thoughts and feelings Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Assisting patients with problem solving to help facilitate activities of daily living Providing the client with opportunities to socialize
Facilitating communication of distressing thoughts and feelings Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Assisting patients with problem solving to help facilitate activities of daily living
A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that apply.) a. "Tell me more about that situation." b. "Let's talk about something else." c. "I notice you are pacing a lot." d. "I'll stay with you a while." e. "Why did you do that?" ANS: A, C, D The correct responses demonstrate use of the therapeutic techniques
a. "Tell me more about that situation." c. "I notice you are pacing a lot." d. "I'll stay with you a while." ANS: A, C, D
A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's most therapeutic response? a. "You sound very upset about this." b. "God always forgives us for our sins." c. "Why do you think you are being punished?" d. "If you feel this way, you should talk to your minister."
a. "You sound very upset about this."
While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest. The patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills
a. Nonverbal communication
Which questions should the nurse ask to determine an individual's worldview? (Select all that apply.) a. What is more important: the needs of an individual or the needs of a community? b. How would you describe an ideal relationship between individuals?NURSINGTB.COM c. How long have you lived at your present residence? d. Of what importance are possessions in your life? e. Do you speak any foreign languages?
a. What is more important: the needs of an individual or the needs of a community? b. How would you describe an ideal relationship between individuals?NURSINGTB.COM d. Of what importance are possessions in your life?
A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at all. What understanding will improve the nurse's planning? These patients are a. members of cultural groups that have a different view of time.NURSINGTB.COM b. immature and irresponsible in health care matters. c. acting-out feelings of anger toward the system. d. displaying passive-aggressive tendencies.
a. members of cultural groups that have a different view of time.
A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication? (Select all that apply.) a. "Why do you think you are so upset?" b. "I can see that you feel sad about this situation." c. "The loss of a close friend is very painful for you." d. "Crying is a way of expressing the hurt you are experiencing." e. "Let's talk about something else because this subject is upsetting you." ANS: B, C, D Reflecting ("I can see that you feel sad," "This is very painful for you") and givin
b. "I can see that you feel sad about this situation." c. "The loss of a close friend is very painful for you." d. "Crying is a way of expressing the hurt you are experiencing." ANS: B, C, D
During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Psychiatric patients should not be touched.
b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.
Which comments by a nurse demonstrate use of therapeutic communication techniques? (Select all that apply.) a. "Why do you think these events have happened to you?" b. "There are people with problems much worse than yours." c. "I'm glad you were able to tell me how you felt about your loss." d. "I noticed your hands trembling when you told me about your accident." e. "You look very nice today. I'm proud you took more time with your appearance."
c. "I'm glad you were able to tell me how you felt about your loss." d. "I noticed your hands trembling when you told me about your accident." ANS: C, D
A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? a. The patient's eye contact should have been directly addressed by role playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patient's poor eye contact is indicative of anger and hostility that were unaddressed. d. The nurse should have assessed the patient's culture before making this diagnosis and plan.
d. The nurse should have assessed the patient's culture before making this diagnosis and plan.
A white patient of German descent rocks back and forth, grimaces, and rubs both temples. What is the nurse's best action? a. Assess the patient for extrapyramidal symptoms. b. Sit beside the patient and rock in sync. c. Offer to pray with the patient. d. Assess the patient for pain.
d. Assess the patient for pain.
Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups? a. Interdependence b. Present orientation c. Flexible perception of time d. Direct confrontation to solve problems
d. Direct confrontation to solve problems
With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A deeply depressed client A tearful client reporting pain A very private client A recent immigrant from Russia
A very private client
Consider the nurse-patient relationship on an inpatient psychiatric unit. Which statement made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? "Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge." "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." "Now that we are working on your problem-solving skills and behaviors, you'd like to change; I'd like to bring up the issue of termination."
"Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge."
Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "From what you have said, you have great difficulty sleeping at night." "Why didn't you attend group this morning?" "It sounds like you have been having a very hard time at home lately." "If I were you, I would quit the stressful job and find something else." "You mentioned that you have never had friends. Tell me more about that." "I'm really proud of you for the way you stood up to your brother when he visited today."
"What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "Why didn't you attend group this morning?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today."
The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question? "Did you do something to cause the illness?" "What do you think is making you ill?" "When did you first feel ill?" "How can I help you get better?"
"What do you think is making you ill?"
A nurse states, "I am so frustrated trying to communicate with clients when they insist on speaking in their language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which response by a peer best promotes culturally competent care? (Select all that apply.) "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." "They will have to learn to speak English eventually to live and work successfully in this country. Just try to be client and encourage them to try speaking English." "You are right, but all clients do have a right to an interpreter, so you need to comply." "I agree that it is frustrating. We should work with their family members to help convince them to speak English." "When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known."
"When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known." "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture."
Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? Offering opinions and avoiding periods of silence Asking open-ended questions and seeking clarification Asking closed-ended questions requiring "yes" or "no" answers Using emotionally charged words and gestures
Asking open-ended questions and seeking clarification
A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization? Unexplained physical pain Recent immigration to the United States Denial of anxiety or depression Impaired sleep patterns
Denial of anxiety or depression
A client is sitting with arms crossed over their chest, with their left leg is rapidly moving up and down, and there is an angry facial expression. When approached by the nurse, the client states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this client? Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Verbal communication is always more accurate than nonverbal communication. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.
Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.
The nurse should be particularly alert to expression of psychological distress through physical symptoms among patients whose cultural beliefs include (Select all that apply) a. mental illness reflects badly on the family. b. mental illness shows moral weakness. c. intergenerational conflict is common. d. the mind, body, and spirit are merged. e. food choices influence one's health.
a. mental illness reflects badly on the family. b. mental illness shows moral weakness. d. the mind, body, and spirit are merged.
A psychiatric nurse leads a medication education group for Hispanic patients. This nurse holds a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After the group, the patients are most likely to believe a. the nurse was uncaring. b. the session was effective. c. the teaching was efficient. d. they were treated respectfully.
a. the nurse was uncaring.
The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is a. clear. b. distorted. c. incongruous. d. inadequate.
b. distorted.
Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American patient diagnosed with a mental illness? a. Encouraging the family to attend community support groups b. Involving the patient's family to assist with activities of daily living c. Providing educational pamphlets to explain the patient's mental illness d. Restricting homemade herbal remedies the family brings to the hospital
b. Involving the patient's family to assist with activities of daily living
A psychoeducational session will discuss medication management for a culturally diverse group of patients. Group participants are predominantly members of minority cultures. Of the four staff nurses below, which nurse should lead this group? a. Very young registered nurse b. Older, mature registered nurse c. Newly licensed registered nurse d. A registered nurse who is very thin
b. Older, mature registered nurse
Preorientation phase
before you meet with client, gather data about client, his or her condition, present situation, examine thought about client (looking at the chart)
A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that." d. "Tell me everything from the beginning."
c. "Am I correct in understanding that."
7. A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. a. "Don't talk that way. Of course you will leave here!" b. "Keep up the good work, and you certainly will." c. "You don't think you're making progress?" d. "Everyone feels that way sometimes."
c. "You don't think you're making progress?"
A Mexican American patient puts a picture of the Virgin Mary on the bedside table. What is the nurse's best action? a. Move the picture so it is beside a window. b. Send the picture to the business office safe. c. Leave the picture where the patient placed it. d. Send the picture home with the patient's family.
c. Leave the picture where the patient placed it.
Which communication strategy would be most effective for a nurse to use during an assessment interview with an adult Native American patient? a. Open and friendly; ask direct questions; touch the patient's arm or hand occasionally for reassurance. b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional face to express negatives. c. Soft voice; break eye contact occasionally; general leads and reflective techniques. d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
A Haitian patient diagnosed with major depressive disorder tells the nurse, "There's nothing you can do. This is a punishment. The only thing I can do is see a healer." The culturally aware nurse assesses that the patient a. has delusions of persecution. b. has likely been misdiagnosed with depression. c. may believe the distress is the result of a curse or spell. d. feels hopeless and helpless related to an unidentified cause.
c. may believe the distress is the result of a curse or spell.
A black patient, originally from Haiti, has a diagnosis of major depressive disorder. A colleague tells the nurse, "This patient often looks down and is reluctant to share feelings. However, I've observed the patient spontaneously interacting with other black patients." Select the nurse's best response. a. "Black patients depend on the church for support. Have you consulted the patient's pastor?" b. "Encourage the patient to talk in a group setting. It will be less intimidating than one-to-one interaction." c. "Don't take it personally. Black patients often have a resentful attitude that takes a long time to overcome." d. "The patient may have difficulty communicating in English. Have you considered using a cultural broker?"
d. "The patient may have difficulty communicating in English. Have you considered using a cultural broker?"
A patient in the emergency department shows a variety of psychiatrical symptoms, including restlessness and anxiety. The patient says, "I feel sad because evil spirits have overtaken my mind." Which worldview is most applicable to this individual? a. Eastern/balance b. Southern/holistic c. Western/scientific d. Indigenous/harmony
d. Indigenous/harmony
A Native American patient sadly describes a difficult childhood. The patient abused alcohol as a teenager but stopped 10 years ago. The patient now says, "I feel stupid and good for nothing. I don't help my people." How should the treatment team focus planning for this patient? a. Psychopharmacological and somatic therapies should be central techniques. b. Apply a psychoanalytical approach, focused on childhood trauma. c. Depression and alcohol abuse should be treated concurrently. d. Use a holistic approach, including mind, body, and spirit.
d. Use a holistic approach, including mind, body, and spirit.
A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after a. identifying culture-bound issues. b. implementing scientifically proven interventions. c. correcting inferior health practices of the population. d. exploring commonly held beliefs and values of the population.
d. exploring commonly held beliefs and values of the population.
To provide culturally competent care, the nurse should a. accurately interpret the thinking of individual patients. b. predict how a patient may perceive treatment interventions. c. formulate interventions to reduce the patient's ethnocentrism. d. identify strategies that fit within the cultural context of the patient.
d. identify strategies that fit within the cultural context of the patient.
