Homework Lance
1.The nurse is attempting to teach a patient how to perform wound care for when he goes home. Using the “teach back” method the nurse should do which of the following?
a.
Repeat the instructions until the patient understands.
b.
Present the information and clarify with closed-ended questions.
c.
Ask the patient if he understands the instructions.
d.
Ask if the patient has any questions about the technique.
ANS: A
The “teach back” technique is an ongoing process of asking patients for feedback, through explanation or demonstration, and presenting information in a new way until you feel confident that you communicated clearly and patients have a full understanding of the information presented. Using teach back can also help you identify explanations and communication strategies that patients most commonly understand. When using the “teach back” technique, do not ask the patient, “Do you understand? or “Do you have any questions?” Instead you should ask open-ended questions to verify the patient’s understanding.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:539
OBJ: Analyze the impact of culture on health, illness, and caring patterns.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
2.A student nurse is caring for a patient of Mexican descent. In an attempt to become culturally aware, the student should consciously think about which of the following?
a.
What people of Mexican descent believe
b.
The relationship between culture and ethnicity
c.
The fact that the patient belongs to an isolated social group
d.
Where the person is in the intersections of socially constructed categories
ANS: D
We must understand a person’s location in the intersections of socially constructed categories of privilege and oppression (e.g., race, class, gender, age, sexual orientation). This is necessary in order to, “fully understand a person’s actions, choices and outcomes.” Culture has historically been associated with norms, values, and traditions passed down through generations. Culture has also been perceived as synonymous with ethnicity, race, nationality, and language. These outdated ideas about culture lead to statements such as, “Mexicans believe this” or “Chinese patients are like this.” In reality, culture is much more dynamic and includes race, ethnicity, gender, sexual orientation, class, immigration status, and other axes of identification. All of us are members of multiple social groups at the same time. These intersecting identities impact our experience of the world around us.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 532 OBJ: Describe steps toward developing cultural competence.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
3.When dealing with cultural awareness, the nurse realizes that the term oppression involves which of the following?
a.
Maintaining advantages based on social group membership
b.
Systems that maintain disadvantages aimed purely at individuals
c.
Intentional discrepancies alone
d.
Issues at institutional levels independent of individual or cultural factors
ANS: A
Oppression involves systems that maintain advantages and disadvantages based on social group membership and operate intentionally and unintentionally, at individual, cultural, and institutional levels.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: 532 OBJ: Use cultural assessment to plan culturally competent care.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
4.The student nurse has been studying different cultures in relationship to nursing. She understands that transcultural nursing has been developed as a distinct discipline and can be defined as which of the following?
a.
Understanding that cultural patterns are generated from predetermined criteria
b.
Knowing that culturally congruent care is based on health care system values
c.
Understanding cultural similarities and differences among groups of people
d.
The realization that illness and disease are the same
ANS: C
Leininger defines transcultural nursing as a comparative study of cultures to understand similarities (culture universal) and differences (culture-specific) across human groups. The goal of transcultural nursing is culturally congruent care, or care that fits a person’s life patterns, values, and a set of meanings. Patterns and meanings are generated from people themselves rather than predetermined criteria. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. To provide culturally congruent care, it is important for you to distinguish between disease and illness. Illness is the way that individuals and families react to disease, whereas disease is a malfunctioning of biological or psychological processes.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF:533 | 534
OBJ: Describe social and cultural influences in health, illness, and caring patterns.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
5.Cultural competence is the ongoing process in which a health care professional continuously strives to achieve the ability to work effectively within the cultural context. To do this effectively, what must the nurse do?
a.
Understand the cultural norms of the patient’s community.
b.
See herself or himself as being culturally competent.
c.
Face the reality that cultural competence can take up to a year to achieve.
d.
View herself or himself as becoming culturally competent.
ANS: D
Cultural competence is the ongoing process in which a health care professional continuously strives to achieve the ability to work effectively within the cultural context of a patient (individual, family, and community). There are a variety of models for how to acquire cultural competence. One model requires nurses to see themselves as becoming culturally competent rather than being culturally competent. It is a developmental process that evolves over a lifetime. Cultural competence goes beyond just understanding cultural norms with a patient’s community—this is only a component of competence.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:535
OBJ:Discuss research findings applicable to culturally competent care.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
6.A student nurse assigned to a female, observant Muslim patient noticed her discomfort with several of the male health care providers. She wonders if this discomfort is related to the patient’s religious beliefs. In her preparation for clinical, she learned that Muslims differ in their adherence to tradition, but that modesty is the “overarching Islamic ethic” pertaining to interaction between the sexes (Rabin, 2010). The student nurse states which of the following to the patient?
a.
“I’m going to request that you only have female physicians see you. Does having male nurses bother you as well?”
b.
“I know that it’s hard to get used to, but you just have to get used to it. That’s how it is in America.”
c.
“It must be difficult for people like you to adjust to our ways, but there are limitations for all of us.”
d.
“I know that for many of our Muslim patients modesty is very important. Is there some way I can make you more comfortable?’
ANS: D
Delivering culturally congruent care to individuals and communities requires specific knowledge, skills, and attitudes. Nurses who provide culturally competent care bridge cultural gaps to provide meaningful and supportive care for all patients. The student nurse states to the patient, “I know that for many of our Muslim patients modesty is very important. Is there some way I can make you more comfortable?” The student did not assume that the information will automatically apply to this patient. Instead, the student combined her knowledge about a cultural group with the attitude of helpfulness and flexibility so as to provide quality patient-centered culturally congruent care.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:535
OBJ: Describe social and cultural influences in health, illness, and caring patterns.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7.The nurse is caring for a patient of a culture different from her own. To provide culturally competent care for this patient, what does the nurse need to do?
a.
Not be curious about other ways of being in the world
b.
Understand the forces that influence her own world view
c.
Recognize that she must not hold any bias toward the patient
d.
Have no predispositions relative toward the patient’s culture
ANS: B
Although curiosity about other ways of being in the world is an important attitude for cultural competence, it is also important for a nurse to understand the forces that influence his or her own world view. Everyone holds biases about human behavior. Bias means a predisposition to see people or things in a certain light, positive or negative (Aguilar, 2006). Becoming more aware of one’s biases and attitudes about human behavior is the first step on the ladder of cultural competence that can lead to positive change.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 535 OBJ: Use cultural assessment to plan culturally competent care.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
8.The current focus on promoting a culturally competent health care environment is on which of the following?
a.
The health care provider’s efforts to become self-aware
b.
The health care provider learning about other cultures
c.
Avoiding the systematic provision of care
d.
Ensuring that cultural competence is integrated into administrative processes
ANS: D
The current focus is toward systemic approaches to ensure that cultural competence is integrated into the administrative processes and the provision of care, rather than avoidance of systematic approaches. In the past, many of the methods to promote a culturally competent health care environment focused on health care providers’ efforts to become self-aware and learn about other cultures.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: 536 OBJ: Use cultural assessment to plan culturally competent care.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
9.The nurse is performing a cultural assessment on a patient. What does the nurse know about cultural assessments?
a.
They are intrusive and time consuming.
b.
They are not dependent on a trusting relationship.
c.
They are rarely plagued by miscommunication.
d.
They are based in similarities of behavior.
ANS: A
In contrast to other types of interviews, cultural assessment is intrusive and time consuming and requires a trusting relationship between participants. Miscommunication commonly occurs in intercultural transactions. This is because of language communication differences between and among participants and differences in interpreting each other’s behaviors. Nurses use transcultural communication skills to interpret a patient’s behavior within his or her own context of meanings and to behave in a culturally congruent way.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: 538 | 539 OBJ: Use cultural assessment to plan culturally competent care.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1.A nurse is in the process of admitting an ethnically diverse patient. To plan culturally competent care, what must the nurse do? (Select all that apply.)
a.
Assume that cultural processes are the same within a social group.
b.
Conduct a systematic cultural assessment.
c.
Communicate effectively.
d.
Negotiate world view differences.
ANS: B, C, D
Critical to success is your ability to conduct a systematic cultural assessment, communicate effectively, and have the skills to negotiate world view differences with others. Cultural processes frequently differ within the same social group (a family, a group of white people, a group of women friends, an immigrant family, a group of nurses) because of differences, for example, in age, gender, political association, class, or religion.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 536 OBJ: Use cultural assessment to plan culturally competent care.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
2.Health care regulatory agencies, national think tanks, and government agencies expect health care organizations to incorporate cultural competence into policies and practices to ensure effective communication, patient safety and quality, and patient-centered care. Some examples of such organizational policies and practices include which of the following? (Select all that apply.)
a.
Instituting a requirement for all staff to be trained in cultural competence
b.
Maintaining the traditional description of family in written policies
c.
Enforcing strict visitation policies and practices
d.
Ensuring that persons who are deaf or speak limited English have access to an interpreter
e.
Embedding health literacy principles in written and verbal communication
ANS: A, D, E
Health care regulatory agencies, national think tanks, and government agencies expect health care organizations to incorporate cultural competence into policies and practices to ensure effective communication, patient safety and quality, and patient-centered care. Some examples of such organizational policies and practices include: instituting a requirement for all staff to be trained in cultural competence, embedding a broad description of family in written policies, expanding visitation policies and practices to include a patient’s preferences, requiring nursing staff to conduct and document a cultural assessment on all patients within the clinical documentation system, ensuring that persons who are deaf or speak limited English have access to an interpreter, and embedding health literacy principles in written and verbal communication.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 536 OBJ: Describe steps toward developing cultural competence.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
3.Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups that are often exacerbated by which of the following? (Select all that apply.)
a.
Social status
b.
Economics
c.
Environment
d.
Improved access to health care
ANS: A, B, C
Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Poor access to health care is one social determinant of health that contributes to health disparities.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF:531OBJ:Describe health disparities.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
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