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Foundations of Psychiatric Mental Health Nursing 5th Edition Varcarolis Halter Test Bank

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Foundations of Psychiatric Mental Health Nursing 5th Edition Varcarolis Halter Test Bank

ISBN13: 9781416000884

ISBN10: 1416000887

 

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Foundations of Psychiatric Mental Health Nursing 5th Edition Varcarolis Halter Test Bank

ISBN13: 9781416000884

ISBN10: 1416000887

 

 

 

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Varcarolis: Foundations of Psychiatric Mental Health Nursing: A

Clinical Approach, 5th Edition

 

Test Bank

 

Chapter 7: Culturally Relevant Mental Health Nursing: A Global Perspective

 

MULTIPLE CHOICE

 

1)   The cultural pattern highly valued in American society that often results in nurses of the dominant culture establishing unrealistic outcomes for clients of other cultural groups is

A. interdependence.
B. present orientation.
C. using direct confrontation to solve problems.
D. suspending one’s own needs in favor of external obligations.

 

ANS:   C

Directly confronting problems is a highly valued approach in the American culture; however, it is not part of many other cultures in which harmony and restraint are valued. American nurses mistakenly think that all clients are capable of taking direct action. Clients with other values will be unable to meet this culturally inappropriate outcome. Option A: This cultural pattern is valued more by indigenous peoples. Option B: Present orientation is not part of Western culture; it is seen more in the Hispanic tradition and indigenous cultures. Option D: This pattern is seen more often in Eastern cultures.

 

DIF:    Cognitive Level: Comprehension

REF:    Text Page: 102, Text Page: 103, Text Page: 104, Text Page: 105

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

2)   The provision of culturally competent nursing care will be fostered when the nurse plans and implements care on the belief that

A. a nursing goal is to foster assimilation and conformity.
B. reading a handbook describing the practices of various cultures is sufficient.
C. the ability to work within the client’s cultural context requires ongoing effort.
D. self-examination of attitudes toward various cultures promotes dehumanizing care.

 

ANS:   C

 

Cultural competence requires health care providers to see themselves as becoming culturally competent rather than being culturally competent. This view requires the provider to continuously strive to work effectively within the cultural context of the client. Option A: Assimilation and conformity may not be desired by the client. Option B: Handbooks can be helpful but do not provide all knowledge. Option D: This action should move the nurse toward providing more humanistic care rather than dehumanizing care.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 109, Text Page: 110

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

3)   To provide culturally competent care after becoming familiar with the way of life of individuals of a particular culture, the nurse will

A. accurately interpret the thinking of individual clients.
B. anticipate how a client will perceive treatment interventions.
C. need to identify strategies that fit within the cultural context of the clients.
D. find it possible to devise interventions to reduce the client’s ethnocentrism.

 

ANS:   C

Cultural competence is a continual process of “becoming” as opposed to a state that is arrived at and maintained without ongoing effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain cultural knowledge and then determine the nursing care measures that clients find acceptable and helpful. Option A: Interpreting the thinking of individual clients cannot be done simply by having knowledge of the culture. Option B: This may be true to some extent: however, because of individual thinking, it cannot be a certainty. Option D: Reducing a client’s ethnocentrism may not be a desired outcome.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 110

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

4)   A clinical specialist supervises therapy for a 26-year-old African American client originally from Haiti who was admitted for depression. A staff nurse tells the clinical specialist that “ The client can’t seem to express her feelings when I ask about them. She just looks down.” The nurse adds, “But I’ve seen her talking to a young African American client, and she seems quite spontaneous.” What remark by the clinical specialist would help the staff nurse develop cultural competence?

A. “Why not ask the other client to tell you what your client tells him. Once you have an opening, your client will become more spontaneous with you.”
B. “Don’t take it personally. African Americans often have a resentful attitude that takes weeks to overcome.”
C. “ She may have difficulty communicating her feelings in standard English. Have you considered using a cultural translator?”
D. “Most African Americans depend on the African American church for support. Why not ask her pastor to come in to pray with the two of you for the success of her treatment?”

 

ANS:   C

Society expects a culturally diverse client to accommodate and use standard English. This may be virtually impossible during episodes of mental illness. Cultural translators can be helpful with language and helping the nurse to understand the Haitian worldview and cultural nuances.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 111, Text Page: 112

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

5)   A Haitian client who has been diagnosed with depression tells the nurse that “There’s nothing you can do. I’m being punished. The only thing I can do is see Sister Ondine. She’s the only one who can take away curses.” How might the culturally knowledgeable nurse assess the situation? The client

A. is feeling hopeless, helpless, and worthless related to some yet-to-be-established cause.
B. may have a delusion of persecution.
C. has probably been misdiagnosed.
D. may believe her distress resulted from a spell cast upon her.

 

ANS:   D

Culturally diverse individuals of African American or Caribbean cultures who have a fatalistic attitude about illness may believe they are being punished for wrongdoing or that they are victims of witchcraft or voodoo. They are usually more reticent to share information about curses with therapists than the client in this scenario, however. Options A and B: No data are present in the scenario to support these assessments. Option C: Misdiagnosis more commonly labels a client with depression as having schizophrenia.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 105

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

6)   An African American client who is highly suspicious is given to angry outbursts and accusations that staff are discriminating against him when they remove possibly harmful objects from his possession according to hospital policy. An explanation that shows cultural awareness relating to the client’s behavior is that it may be prompted by

A. feelings of powerlessness.
B. institutional discrimination.
C. fear of abandonment.
D. family solidarity.

 

ANS:   A

The rules of the health care system often seem like added measures of oppression to African Americans, who respond with behavior designed to fend off feelings of powerlessness and vulnerability. The other options have no bearing on the situation.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 110

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

7)   The nurse in the outpatient medication clinic has a full appointment book. A Hispanic American client misses his 10 AM appointment, arriving at 12:30 PM, and a Native American client does not keep her appointment at all. What understanding on the part of the nurse will lead to satisfactory planning? These culturally diverse clients are

A. members of cultural groups that have a different view of time.
B. immature and irresponsible in health care matters.
C. displaying passive-aggressive tendencies.
D. acting out feelings of anger toward the system.

 

ANS:   A

Hispanic Americans and Native Americans traditionally treat time in a way unlike the “American” culture. They tend to be present-oriented; that is, they value the current interaction more than what is to be done in the future. Thus, if engaged in an activity, they may simply continue the activity and appear hours or days later for an appointment. Understanding this, the nurse can avoid feelings of frustration and anger when the nurse’s future orientation comes into conflict with the client’s present orientation.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 101, Text Page: 102

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

8)   The sibling of a client who is a single Asian American college student tells the nurse “My sister needs help for the pain in her back. She goes crazy—screaming and crying, like when they brought her to the hospital, from the hurt.” What understanding on the part of the nurse will contribute to a culturally relevant care plan? The client

A. will require a prolonged hospitalization to stabilize these symptoms.
B. will probably respond best to a therapist who remains aloof and ungiving.
C. may express emotional distress with physical symptoms and look to health professionals to treat the physical symptoms.
D. has an independent worldview and must be treated without consideration to information given by family members.

 

ANS:   C

The orientation that psychological problems are caused by a physical imbalance is prevalent among Asian Americans. These clients often expect healers to focus on treatment of the physical symptoms and believe the psychological symptoms will then subside. Option A: Hospitalization will likely be short. Option B: The client will probably respond best to a therapist who is perceived as giving; thus giving a medication to treat the back pain would be expected by the client. Option D: Asian Americans usually have strong family ties. Information from the family may be invaluable.

 

DIF:    Cognitive Level: Application

REF:    Text Page: 105, Text Page: 106, Text Page: 107, Text Page: 108

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

9)   The communication style that would be most effective for a culturally knowledgeable nurse to adopt during an assessment interview with a 40-year-old Native American client would be

A. the frequent use of nonverbal behaviors such as gesturing, smiling, and making wry faces to express negatives.
B. a loud voice, unbroken eye contact, minimal gesturing, and straight-to-the-point questions.
C. to be open and friendly, ask direct questions, and touch the client’s arm or hand occasionally for reassurance.
D. a soft voice, breaking eye contact occasionally, with general leads and reflective techniques.

 

ANS:   D

Native American culture stresses living in harmony with nature. Cooperative, sharing styles rather than competitive or intrusive approaches are preferred; thus the more passive style described in option 4 would be best received. The other options would be more effective to use with clients with a Western orientation.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 110, Text Page: 111

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

10)   A Native American client describes having difficulty learning as a child, living on a reservation, and being sent away to the Native American boarding school. He began to use alcohol as a teenager to feel euphoria and escape the feelings of isolation. As an adult he states he feels “stupid and good for nothing.” Gastritis forced him to give up drinking 10 years ago. Recently, he has found some comfort in tribal rituals. In planning care for this client the nurse should realize that he should be offered a program based on

A. treatment for both depression and alcohol abuse.
B. group discussion of posttraumatic stress disorder.
C. holistic principles.
D. psychoanalysis.

 

ANS:   C

Native Americans, because of their beliefs in the interrelatedness of parts and about being in harmony with nature, respond best to a holistic approach. Option A: No data are present to support dual diagnosis because the client has resolved the problem of excessive alcohol use. Option B: No data are present to support a diagnosis of posttraumatic stress disorder. Option D: Psychoanalysis is a long-term therapy that is very expensive. Cognitive therapy might be a better choice.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 102

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

11)   A Native American client describes having difficulty learning as a child, living on a reservation, and being sent away to the Native American boarding school. He began to use alcohol as a teenager to feel euphoria and escape the feelings of isolation. As an adult he states he feels “stupid and good for nothing.” The nursing diagnosis a culturally competent nurse should consider developing for him is

A. risk for other-directed violence.
B. chronic low self-esteem.
C. deficient knowledge.
D. noncompliance.

 

ANS:   B

The client has given several indications that he has chronic low self-esteem. Forming a positive self-image is often difficult for Native American individuals because these indigenous people must blend together both American and Native American worldviews. No defining characteristics are present for any of the other nursing diagnoses mentioned.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 109

TOP:    Nursing Process: Nursing Diagnosis

MSC:   NCLEX: Psychosocial Integrity

 

 

12)   To plan effective care, the nurse needs to understand that the family characteristic reflecting the worldview of Asian American and Hispanic American families that will most affect how decisions are made about care is

A. the mother as head of the household.
B. the father as the authority figure.
C. giving considerable freedom to women.
D. using emotional communication styles.

 

ANS:   B

Both Asian American and Hispanic American families traditionally place the father in the position of power as the head of the household. Option A: The mother is usually subservient to the father in these cultures. Option C: Women are often placed in subservient roles, and adolescent girls are sheltered in both cultures. Option D: Hispanic Americans may use a communication style that is high in affect, but Asian Americans are more likely to be reserved.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 105

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

13)   The client, a newly arrived Russian immigrant, was admitted to the mental health unit after creating a disturbance in a church while a funeral was taking place. During the admission interview he is loud, mixes English and Russian phrases, and makes gestures such as vigorously shaking his fist. The nurse responsible for admitting him should

A. tell him she is going to ask him some questions that he must try to answer in English.
B. defer the nursing admission interview until after the client has calmed down.
C. request the assistance of a security guard.
D. request the assistance of an interpreter.

 

ANS:   D

A psychotic client who is mixing English and his or her native language cannot be accurately assessed by an English-speaking nurse who does not speak the other language. The care plan should be based on accurate assessment data; hence calling for an interpreter is necessary and expedient. Most hospitals have a list of individuals who are fluent in various languages and are willing to assist the medical staff. Option A will not produce the desired result if the client is disorganized and unable to comply. Option B: Assessment information is necessary to obtain if at all possible. Deferring the interview should not be an initial option. Option C: Data do not suggest the client is aggressive, although fist-shaking might be interpreted as aggressive in some cultural contexts.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 106

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

14)   The statement relating to conceptions of self that will help a nurse accurately assess culturally diverse clients and plan care is

A. The Western conception of self is the ego, the aspect of personality that mediates demands of the id, the superego, and the environment. The definition of self in the interdependent worldview tradition is described as a web of relationships and expectations of the hierarchical group.
B. The conception of self of indigenous peoples is an unbounded ego interacting primarily with family. The Western self is defined in the context of collective family genealogy traced from male lineage over centuries.
C. The Western worldview views self as being independent and isolated from family and community. The Eastern worldview defines self in terms of the relationship with all of nature.
D. The Eastern worldview sees self as independent of family and social relationships, with little emphasis on duty. Western tradition views self as interdependent, interrelated, and connected with all ancestors and community.

 

ANS:   A

The Western self is individual and focuses on articulation of one’s own ideas, desires, and needs as well as on goal attainment and is consistent with an independent worldview. The interdependent worldview is exemplified in Asian cultures, in which self is incomplete and part of a cooperative hierarchical group of insiders with common needs, goals, and concerns. The Native American self also exemplifies an interdependent worldview with self linked with all other living things. Two other cultures that exemplify an interdependent worldview are the Arabic culture, in which self is viewed as part of a group that includes a lineage, and one’s value is derived from the social unit, and the African culture, where self includes one’s ancestors, nature, and community.

 

DIF:    Cognitive Level: Comprehension      REF:    Text Page: 101, Text Page: 102

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

15)   A Hispanic client whose only child died of pneumonia over a year ago states that she is unable to go about her usual home duties and community interactions because of debilitating headaches and backaches. The psychiatrist diagnoses depression. Her primary care nurse tells the clinical nurse specialist “I can’t seem to help her. All she talks about are the headaches and the backaches.” The clinical nurse specialist can foster the cultural competence of the nurse by saying

A. “You need to be patient and let her take the lead.”
B. “You must take the lead and focus on the reason for her resistance.”
C. “In her culture, physical symptoms are idioms of distress expressing emotional pain.”
D. “You might ask the client why she has chosen to grieve for her child in this particular way.”

 

ANS:   C

Nurses often need to be sensitized to client use of physical symptoms as a means of expressing psychological pain. Somatic equivalents are seen in clients of the Western culture as well.

 

DIF:    Cognitive Level: Application

REF:    Text Page: 106, Text Page: 107, Text Page: 108

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

16)   A client who is Chinese American has been diagnosed with an anxiety disorder. The client tells the nurse she thinks her symptoms began when her energy became imbalanced. When the nurse asks what ideas the client has about ways of treating the imbalance, the nurse should expect the client to suggest a plan for

A. eating special foods.
B. taking antianxiety medication.
C. undergoing cognitive behavior therapy.
D. having a native healer perform a ritual.

 

ANS:   A

The concept of energy imbalance as a source of illness is an explanatory model familiar to Asian cultures. A source of healing is dietary change to include either “hot” or “cold” foods to correct the imbalance. “Hot” and “cold” in this case do not refer to thermal properties of the foods. Option B would not be a first-line option for a client with an Eastern worldview. Herbal remedies are more in keeping with this worldview. Option C: Cognitive therapy would not be a treatment suggested by a client with an Eastern worldview. Option D: This remedy would be suggested by someone from an indigenous culture.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 105

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

17)   A psychiatric nurse with 3 years of inpatient experience has been assigned to work in a medication follow-up clinic beginning Monday. The clinic sees culturally diverse clients. To prepare for work in the clinic it would be advisable for the nurse to

A. review the literature on cultural differences in client responses to psychotropic medications.
B. read a handbook on the various health beliefs of members of diverse cultures.
C. contact the clinical nurse specialist for guidelines for cultural competence.
D. take a course in psychopharmacology.

 

ANS:   A

A nurse with 3 years’ experience working on a mental health inpatient unit can be assumed to be familiar with the action and side effects of most commonly prescribed psychotropic medications. However, because culturally diverse clients are seen in the clinic, reviewing cultural differences in client response to these medications could be helpful. One such difference is the development of extrapyramidal side effects at lower drug doses in Asian clients. Options B and C: Neither is sufficient to produce cultural competence. Option D: This might be helpful in the long run, but the nurse begins work at the clinic on Monday.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 108

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Physiologic Integrity

 

 

18)   A mental health nurse with 3 years of inpatient experience is about to begin work in a medication follow-up clinic that serves a culturally diverse client population. Which way of sitting during an interview is most neutral and acceptable to people of most cultures?

A. Legs crossed, leaning slightly backward in chair with one arm extended on the desk
B. Feet on the floor and upper body leaning slightly forward toward client
C. One leg crossed and the upper body turned slightly away from client
D. Feet on the floor and arms crossed over chest

 

ANS:   B

The correct pose is most neutral related to arms and legs. Leaning slightly forward denotes interest in the person toward which the nurse is inclined. Option A: Leg crossing is not accepted in some cultures, and leaning backward suggests the individual is placing the barrier of space between self and the other person. Option C: Crossing the leg to show the bottom of the foot is considered impolite in some cultures. Turning away suggests distancing. Option D: Crossing the arms over the chest is considered a “closed” authoritarian posture.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 106

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

19)   A client who is a believer in Ayurvedic medicine (traditional remedies) has agreed to take antidepressant medication but tells the nurse that she also wishes to treat her symptoms with healing practices consistent with her own beliefs. The priority question the nurse should ask the client is

A. “Will be doing special breathing exercises?”
B. “How will astrology figure into your treatment plan?”
C. “What, if any, herbs do you plan to take?”
D. “Will your treatment include yoga?”

 

ANS:   C

The nurse needs to make sure that any herbs the client may take are not harmful when taken in conjunction with the prescribed antidepressants. Options A, B, and D are considered complementary treatments and are of somewhat less concern because they do not involve harmful interactions among ingested substances.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 105

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Physiologic Integrity

 

 

20)   The nurse is caring for a family in which four members have tuberculosis. The family describes its health system to the nurse, noting that shamanic healing is used. The nurse will have the greatest success in planning treatment if she creates a plan that uses antituberculin medication as well as

A. services of a folk healer.
B. behavior therapy.
C. acupuncture.
D. yoga.

 

ANS:   A

Shamanic healing considers that all things have spirit. Healing practices include rituals, cleansings, and prayers delivered by a shaman or folk healer. Folk healing rituals can be successfully combined with Western medicine. Accommodating culture-specific interventions builds on client coping and healing systems. Option B: Behavior therapy would be of less cultural significance to the family than folk healing. Options C and D: These complementary therapies were not specifically described by the client as being part of her health system.

 

DIF:    Cognitive Level: Application             REF:    Text Page: 105

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

21)   Which question would help the nurse assess feminist issues governing the availability of healing options for a woman of a culture with an Eastern interdependent worldview?

A. “What does someone of your culture call this illness?”
B. “How does someone with this illness usually behave?”
C. “How does being a woman affect someone with this illness?”
D. “How do people of your culture express dislike or displeasure?”

 

ANS:   C

This question will help the nurse understand a woman’s importance in the culture. In a culture in which women play a lesser role, healing options may not be readily available. Option A: This question would help assess culture-bound illness. Option B: This question relates to sick roles, pain expression, and predominant symptoms. Option D: This question is more related to general cultural factors than women’s issues.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 100, Text Page: 101

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

22)   During the assessment interview the nurse has ascertained that the client follows cultural tradition and uses spiritual healing. The question that would help the nurse understand the healing options available as part of this health system is

A. “What do people believe cause this illness?”
B. “Do people shun or avoid someone who has this illness?”
C. “Are any ceremonies or prayers used to treat this illness?”
D. “What language do your people generally use when speaking among yourselves?”

 

ANS:   C

Option C is the only question that directly addresses healing options.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 111, Text Page: 112

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

23)   The hospice nurse planning care for four culturally diverse clients, each of whom has terminal cancer, should anticipate that the client who will wish to engage in end-of-life planning (such as making a will, a living will, and funeral arrangements) will be the client who is

A. a single Native American who had worked as a forest ranger.
B. a female immigrant from China who is an acupuncturist.
C. a refugee laborer from a war-torn Western African country.
D. a fourth-generation New England native who is an accountant.

 

ANS:   D

This client would hold a Western worldview and value autonomy, independence, and self-reliance. He would see time as linear and would have an internal locus of control. Self-action would be a high priority. Options A and C: The clients would hold indigenous worldviews. Option B: The client would hold an Eastern worldview. For options A, B, and C, the concept of person is defined more in relationship to others, and the locus of control is self-rooted in tradition or in natural forces. The need for independence and self-reliance is far less. Tradition, fate, or other forces are seen as being in control.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 102

TOP:    Nursing Process: Planning                 MSC:   NCLEX: Psychosocial Integrity

 

 

24)   A health care aide caring for a mentally ill client receiving home care insists that the client must balance energy forces of his body by eating specific foods. The client tells the nurse that he “goes along with the diet to keep the aide happy.” The community psychiatric nurse should assess this situation as demonstrating

A. biculturalism.
B. cultural imposition.
C. culture-bound syndrome.
D. preserve-accommodate-restructure phenomenon.

 

ANS:   B

Cultural imposition occurs when a member of one culture forces a member of another culture to adhere to the certain cultural norms. Option A refers to the ability to move back and forth between traditional culture and a new culture. Option C: A culture-bound illness refers to the behavior that one culture understands as illness but that is not so designated in other cultures. Option D refers to a framework for care planning that preserves helpful aspects of client culture, accommodates neutral practices, and restructures problematic patterns.

 

DIF:    Cognitive Level: Application

REF:    Text Page: 102, Text Page: 103, Text Page: 104, Text Page: 105

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

25)   A client has inferred that her symptoms of depression are related to an imbalance of yin and yang. A query that should elicit information to guide treatment and nursing care designed to accommodate the client’s culture is

A. “Are you concerned about treatment in a hospital setting?”
B. “ Are you willing to take Western medications to treat your illness?”
C. “Who should receive information about your health problems?”
D. “What foods should a person with this illness eat?”

 

ANS:   D

Accommodation involves including neutral health practices in the client’s plan of care. A diet that addresses correcting yin and yang imbalance would probably be psychologically helpful and would not be likely to interfere with Western medical treatment with selective serotonin reuptake inhibitors. Options A and C are not relevant to accommodation of diverse cultural health practices. Option B would be more related to restructuring.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 111, Text Page: 112

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

26)   The psychiatric home care nurse makes visits a Hispanic client being treated for depression. The client greets the nurse with a smile and eagerly offers to make coffee. The nurse initiates a handshake, politely refuses the coffee so as not to make work for the client, and suggests they talk about how the client is doing. During the session the nurse notes the client seems less spontaneous in affect and becomes more withdrawn. In analyzing the situation the nurse should correctly conclude that

A. the client is experiencing rapid cycling.
B. the client may feel rejected by the nurse.
C. the nurse has broached a taboo topic.
D. social touch is inappropriate for Hispanic clients.

 

ANS:   B

In the Hispanic culture, good etiquette requires accepting offers of food and spending some time in small talk before getting down to business. The nurse behaved impolitely by the client’s standards. Option A: Rapid cycling is related to rapid mood swings of bipolar disorder. Option C: Data are not present to suggest that the nurse touched on a taboo topic. Option D: Clients of Hispanic culture engage in “high touch” behaviors.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 103

TOP:    Nursing Process: Evaluation              MSC:   NCLEX: Psychosocial Integrity

 

 

OTHER

 

1)   A nurse is assigned to work with a single Asian American college student. The nurse tells a colleague that the client has very poor eye contact, and that no matter what strategies he uses to try to get her to meet his gaze, she will not look directly at him. Which of the following explanations would be possible reasons for the client’s behavior? In some Asian cultures (more than one answer may be correct)

  1. a strong cultural injunction exists against using assertive communication measures.
  2. looking directly at a person of the opposite sex indicates sexual interest.
  3. looking down signifies deference to authority.
  4. trancelike syndromes are common.

 

ANS:

A, B, C

Rationale: Options A, B, and C describe cultural beliefs often held by Asian American groups. They are each based on valuing concepts of respect and restraint. Although trancelike syndromes do occur among members of certain cultures, they are not related to this situation.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 103

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

 

2)   Which of the following tips would be useful to an American nurse preparing for a cross-cultural encounter with a female client from Japan? (More than one answer may be correct.)

  1. Anticipate diversity.
  2. Promote a feeling of acceptance.
  3. Learn what it means to be the client by assessing health beliefs.
  4. Facilitate communication by using direct eye contact and a handshake.
  5. Remember that all Eastern women adhere to the same cultural norms.

 

ANS:

A, B, C

Rationale: Options A, B, and C are helpful hints. Option A: Anticipating diversity puts the nurse in a position of guarding against stereotyping and opens the nurse to cultural awareness. Option B: Promoting feelings of acceptance prevents cultural pain. Option C: Learning about the position of the client facilitates empathy. Option D: The least useful strategy would be to use direct eye contact and touch. In a cross-cultural encounter strategies known to be acceptable to the client are preferable. When particular strategies have not been identified, try to avoid offending the client. Direct eye contact and touch may be offensive to clients whose culture calls for more reserved cultural practices. Option E: This stereotype may lead to culturally insensitive care decisions.

 

DIF:    Cognitive Level: Analysis                  REF:    Text Page: 105

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

3)   According to the values of cultures whose members use folk healing practices, the factors most important for a nurse to possess include (more than one answer may be correct)

  1. ethnocentrism.
  2. cultural skill.
  3. cultural desire.
  4. cultural knowledge.
  5. academic credentials.
  6. respect for persons.

 

ANS:

B, C, D, F

Rationale: Cultural skill allows the nurse to make culturally sensitive assessments and plan for care. Cultural desire refers to willingness to learn from the client. Cultural knowledge alerts the nurse to areas where cultural differences may be present, helps with understanding, and reduces misinterpretations. Respect for persons is important to members of all cultures and is part of cultural desire. Option A: Ethnocentrism may result in imposing the nurse’s cultural norms on a client. Option E: Academic credentials are not of concern because curative factors in healing systems focusing on folk healing. More important are collaboration with cultural translators and extensive involvement with the family and the community when delivering education and making treatment plans.

 

DIF:    Cognitive Level: Application

REF:    Text Page: 106, Text Page: 107, Text Page: 108, Text Page: 109, Text Page: 110

TOP:    Nursing Process: Implementation

MSC:   NCLEX: Safe, Effective Care Environment;

 

 

4)   The nurse should be particularly alert to somatization of psychological distress among clients whose cultural beliefs include the idea that (more than one answer may be correct)

  1. mental illness reflects badly on a family.
  2. mental illness is a significant moral weakness.
  3. everyone should plan for the future.
  4. mind, body, and spirit are merged.
  5. intergenerational conflict is to blame.

 

ANS:

A, B, D

Rationale: Physical symptoms are seen as more acceptable in cultural groups in which interdependence and harmony of the group are emphasized. Mental illness is often perceived as reflecting a failure of the entire family. In groups in which mental illness is seen as a moral weakness and both the individual and family are stigmatizedRemember,matization of mental distress is better accepted. In groups in which mind, body, and spirit are holistically perceivedRemember,matization of psychological distress is readily effected. Option C: Somatization is seen among clients with both future and present orientation to time. Option E: Intergenerational conflict has not been noted as a risk factor for somatization.

 

DIF:    Cognitive Level: Comprehension

REF:    Text Page: 106, Text Page: 107, Text Page: 108, Text Page: 109

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

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