Deck 6: Cultural Implications for Psychiatric Mental Health Nursing

Question 1

A Native American patient describes difficulty learning as a child,living on a reservation,and being sent away to a Native American boarding school.The patient began using alcohol as a teenager to escape feelings of isolation but stopped 10 years ago when gastritis developed.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) Group therapy for treatment of posttraumatic stress disorder
B) Simultaneous treatment of depression and alcohol abuse
C) Psychoanalytic approach
D) Holistic approach

Answer 1

Holistic approach

Question 2

A Chinese American patient diagnosed with an anxiety disorder says,"My problems began when my energy became imbalanced." When the nurse asks for the patient's ideas about how to treat the imbalance,the patient may request:

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

Answer 2

eating special foods.

Question 3

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.

Answer 3

identify strategies that fit within the cultural context of the patient.

Question 4

A Hispanic patient whose only child died over a year ago says,"I cannot do my usual home duties or go out in my community because of my headaches and backaches." The patient is diagnosed with major depression.The staff nurse says in the team meeting,"I can't help her.All she talks about is pain in her body." Which feedback from the team will be most helpful to this nurse?

A) "You should take the lead and focus on reasons for her resistance to therapy."
B) "In her culture,physical symptoms are expressions of distress and emotional pain."
C) "Ask the patient why she has chosen to grieve her child's death in this particular way."
D) "It will take the antidepressant medication about 3 weeks to reach therapeutic levels.Be patient."

Question 5

A Russian immigrant created a disturbance while at a funeral.This person was loud,mixed English and Russian phrases,and made dramatic gestures.Police take the person to the emergency department.The nurse assessing this person should:

A) defer the nursing assessment interview until after the person has calmed down.
B) say,"I am going to ask you some questions.Try to answer in English."
C) request a security guard be available during the assessment.
D) request assistance by an interpreter.

Question 6

The sibling of an Asian American 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? The patient:

A) may 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.

Question 7

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.

Question 8

A mental health nurse works in a community-based medication clinic that serves a culturally diverse patient population.Which way of sitting during an interview is most neutral and acceptable to people of a variety of 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 patient
C) One leg crossed and the upper body turned slightly away from patient
D) Feet on the floor and arms crossed over chest

Question 9

An experienced psychiatric nurse plans to begin work in a community-based medication clinic on Monday.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) Examine the literature on 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.

Question 10

A Haitian patient diagnosed with depression tells the nurse,"There's nothing you can do.This is a punishment.The only thing I can do is see a healer." How might the culturally knowledgeable nurse assess the situation? 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) is feeling hopeless and helpless related to some unidentified cause.

Question 11

An African American patient,originally from Haiti,was admitted for depression.A staff nurse tells a peer,"This patient frequently looks down and does not express feelings.When I observe interactions with other African American patients,however,the patient appears spontaneous." What remark by the peer would be most helpful?

A) "Most African Americans depend on the church for support.Have you consulted the patient's pastor?"
B) "Ask the patient to describe feelings in a group setting.It will be less intimidating than one-to-one interaction."
C) "Don't take it personally.African Americans often have a resentful attitude that takes a long time to overcome."
D) "The patient may have difficulty communicating feelings in English.Have you considered using a cultural broker?"

Question 12

An African American patient is suspicious,has angry outbursts,and accuses staff of discriminating when they remove possibly harmful objects.Which factor best demonstrates cultural awareness regard this patient's behavior?

A) The patient may have feelings of powerlessness.
B) Family solidarity is this patient's priority need.
C) Institutional policies promote discrimination.
D) The patient fears abandonment.

Question 13

Which communication style would be most effective to use during an assessment interview with an adult Native American patient?

A) Open and friendly;ask direct questions;touch the patient occasionally for reassurance.
B) Frequent nonverbal behaviors such as gestures,smiles,and making a wry face to express negatives.
C) Soft voice;break eye contact occasionally;general leads and reflective techniques.
D) Loud voice;unbroken eye contact;minimal gestures;direct questions.

Question 14

A Native American patient describes difficulty learning as a child,living on a reservation,and being sent away to a Native American boarding school.The patient began using alcohol as a teenager to escape feelings of isolation but stopped 10 years ago when gastritis developed.The patient now says,"I feel stupid and good for nothing.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) Nonadherence

Question 15

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

Question 16

A Native American hospitalized with auditory and visual hallucinations says,"My father said I should kill myself to save me from bad spirits." The patient's father is deceased.Which intervention would most appropriate?

A) After the patient becomes comfortable in the hospital setting,encourage description of the visions in a group setting.
B) Explain to the patient that there are no evil spirits and these symptoms demonstrate grief related to the father's death.
C) Obtain the patient's consent then consult the family for a spiritual healer from the patient's tribe.
D) Provide the patient with private time to meditate and pray.

Question 17

A depressed patient believes in traditional remedies but agrees to take an antidepressant medication.The patient tells the nurse,"I will also treat my symptoms with my own healing practices." Select the nurse's most important response.

A) "You agreed to take this prescription.You must avoid herbal remedies."
B) "What herbs and special foods do you plan to use?"
C) "Will your treatment include yoga or meditation?"
D) "Will you do special breathing exercises?"

Question 18

Which intervention best demonstrates that a nurse understands the cultural needs of a hospitalized Asian-American patient with 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

Question 19

A nurse in the clinic has a full appointment schedule.A Hispanic American patient arrives at 12:30 PM for a 10 AM 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.
B) immature and irresponsible in health care matters.
C) acting out feelings of anger toward the system.
D) displaying passive-aggressive tendencies.

Question 20

A Hispanic woman comes to the mental health center at the urging of her adult children.The patient has lost 5 pounds since her husband's death 6 months ago and says,"My husband comes to visit me in the night but I cannot understand what he says." How should the nurse analyze this situation? The patient is:

A) experiencing auditory and visual hallucinations.
B) at high risk for imbalanced nutrition.
C) grieving the husband's death.
D) denying the husband's death.

Question 21

MATCHING
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column.solve it from the right column may be used more than once.
Hwa-byung

A)Navajo
B)Korean
C)Latin American
D)Chinese

Question 22

The psychiatric nurse makes a home visit to a Hispanic patient with major depression.The patient greets the nurse,smiles,and eagerly offers to make coffee.The nurse initiates a handshake,politely refuses the coffee,and suggests they talk about the patient's progress.During the session,the nurse notes the patient becomes less spontaneous and more withdrawn.The nurse should correctly analyze that:

A) social touch is inappropriate for Hispanic patients.
B) the patient may feel rejected by the nurse.
C) the patient is experiencing rapid cycling.
D) the nurse introduced a forbidden topic.

Question 23

A Mexican American patient puts a picture of the Virgin Mary on the bedside table.What is the nurse's best action?

A) Leave the picture where the patient placed it.
B) Send the picture to the business office safe.
C) Move the picture so it is beside a window.
D) Pray with the patient.

Question 24

Which question would best help a nurse assess feminist issues regarding treatment options for a woman of a culture with an Eastern 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?"

Question 25

Which tip(s)would be useful for an American nurse preparing for an encounter with a female patient from Japan? (Select all that apply. )

A) Anticipate diversity.
B) Promote a feeling of acceptance.
C) Assess the patient's health beliefs.
D) Facilitate communication by using direct eye contact.
E) Recognize that all Eastern women adhere to the same cultural norms.

Question 26

A health care aide insists that a patient with mental illness eat specific foods to balance energy forces.The patient tells the nurse,"I go along with the diet to keep my aide happy." Which phenomenon is evident?

A) Biculturalism
B) Enculturation
C) Cultural imposition.
D) Culture-bound syndrome

Question 27

MATCHING
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column.solve it from the right column may be used more than once.
Ataque de nervios

A)Navajo
B)Korean
C)Latin American
D)Chinese

Question 28

MATCHING
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column.solve it from the right column may be used more than once.
Wind illness

A)Navajo
B)Korean
C)Latin American
D)Chinese

Question 29

A nurse working with a single,Asian American college student tells a colleague,"The patient has very poor eye contact.No matter what strategies I use,this patient will not look at me." Which explanation(s)would be likely reasons for this patient's behavior? In some Asian cultures: (Select all that apply. )

A) a strong cultural injunction exists against using assertive communication measures.
B) looking directly at a person of the opposite sex indicates sexual interest.
C) looking down signifies deference to authority.
D) a close personal space is therapeutic.
E) trancelike syndromes are common.

Question 30

MATCHING
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column.solve it from the right column may be used more than once.
Susto

A)Navajo
B)Korean
C)Latin American
D)Chinese

Question 31

MATCHING
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column.solve it from the right column may be used more than once.
Ghost sickness

A)Navajo
B)Korean
C)Latin American
D)Chinese

Question 32

Which belief best fosters provision of culturally competent nursing care? (Select all that apply. )

A) Eye contact promotes nonverbal communication.
B) Nurses should foster assimilation and conformity to the dominant culture.
C) Reading about practices of various cultures will ensure cultural competence.
D) The ability to work within a patient's cultural context requires ongoing effort.
E) Self-examination of attitudes toward various cultures promotes competent care.

Question 33

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.

Question 34

The nurse should be particularly alert to somatization of psychological distress 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) food choices influence one's health.
D) the mind,body,and spirit are merged.
E) intergenerational conflict is common.

Question 35

A patient with depression infers that symptoms result from an imbalance of yin and yang.Select the best question to elicit information to guide nursing care that will accommodate the patient's culture.

A) "Who should receive information about your health problems?"
B) "Are you concerned about treatment in a hospital setting?"
C) "Are you willing to take Western medications?"
D) "What foods will help this problem?"

Question 36

A hospice nurse plans care for four culturally diverse patients,each of whom has advanced cancer.Which patient will most likely wish to engage actively in end-of-life planning?

A) Native American;worked as a forest ranger
B) Female immigrant from China;acupuncturist
C) Refugee laborer from war-torn African country
D) Fourth-generation New England native;accountant

Question 37

Which term best describes the study of why an African American patient may have a different response to a psychotropic medication as compared to an Asian American patient?

A) Ethnopharmacology
B) Pharmacodynamics
C) Neurasthenia
D) Genetics