Question 1

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:

Accepted Answer

Asian Americans commonly express psychological distress as a physical problem.The patient may believe psychological problems are caused by a physical imbalance.Treatment will likely be short.The patient will probably respond best to a therapist who is perceived as giving.Asian Americans usually have strong family ties and value hope more than truth.

Question 2

Which communication techniques would be most effective for a nurse to use during an assessment interview with an adult Native American patient?

Accepted Answer

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 would be best received.The other options would be more effective to use with patients of a Western orientation.

Question 3

A patient in the emergency department shows a variety of psychiatric 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?

Accepted Answer

Persons of an indigenous worldview believe disease results from a lack of personal,interpersonal,environmental,or spiritual harmony and that evil spirits exist.The holism of body-mind-spirit is a key component of this view.If one believes an evil spirit has taken control,distress results.Western and Eastern worldviews do not embrace spirits.See relationship to audience response question.

Question 4

A nurse prepares to teach important medication information to a patient of Mexican heritage.How should the nurse manage the teaching environment?

Accepted Answer

Latin American cultures use close personal space,closer than many other minority groups.
Standing very close to the patient frequently indicates acceptance.Direct eye contact should not be prolonged with this patient.Persons of this cultural heritage have high emotionality.

Question 5

A nurse speaks with family members of a Chinese American parent recently diagnosed with major depression.Which comment by the nurse will the family find most comforting? "The nursing staff will:

Accepted Answer

Chinese Americans hold an Eastern (balance)worldview.Persons who are ill or need health care are vulnerable and need protection.The family will find comfort in a nurse's statement that good care will be provided.The distracters apply to persons with a Western or indigenous worldview.

Question 6

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?

Accepted Answer

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.Medication would not be a treatment suggested by a patient with an Eastern worldview.Someone from an indigenous culture may suggest rituals.Group discussion of mental illness would not be appealing to a Chinese American.

Question 7

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?

Accepted Answer

An experienced nurse working on a mental health inpatient unit would be familiar with the action and side effects of most commonly prescribed psychotropic medications.However,because the clinic serves a culturally diverse population,reviewing cultural differences in patients' responses to these medications is helpful and vital to patient safety.The distracters identify actions the nurse would take later.

Question 8

Which viewpoint of an Asian American family will most affect decision making about care?

Accepted Answer

Asian American families traditionally place the father in the position of power as the head of the household.Mothers,as well as other women,are usually subservient to fathers in these cultures.Asian Americans are more likely to be reserved.

Question 9

Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American patient diagnosed with a mental illness?

Accepted Answer

The Asian community values the family in caring for each other.The Asian community uses traditional medicines and healers,including herbs for mental symptoms.The Asian community describes illness in somatic terms.The Asian community attaches a stigma to mental illness,so interfacing with the community would not be appealing.

Question 10

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:

Accepted Answer

Hispanic individuals usually value relationship behaviors.Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task.

Question 11

A group activity on an inpatient psychiatric unit is scheduled to begin at 1000.A patient,who was recently discharged from United States Marine Corps,arrives at945.Which analysis best explains this behavior?

Accepted Answer

Culture is more than ethnicity and social norms; it includes religious,geographic,socioeconomic,occupational,ability- or disability-related,and sexual orientation-related beliefs and behaviors.In this instance,the patient's military experience represents an aspect of the patient's behavior.The military culture values timeliness.The distracters represent misinterpretation of the patient's behavior and have no bearing on the situation.

Question 12

A black patient,originally from Haiti,has a diagnosis of depression.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.

Accepted Answer

Society expects a culturally diverse patient to accommodate and use English.Feelings are abstract,which requires a greater command of the language.This may be especially difficult during episodes of high stress or mental illness.Cultural brokers can be helpful with language and helping the nurse to understand the Haitian worldview and cultural nuances.

Question 13

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?

Accepted Answer

The patient has given several indications of 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 the other nursing diagnoses.

Question 14

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." The culturally aware nurse assesses that the patient:

Accepted Answer

Individuals of African American or Caribbean cultures who have a fatalistic attitude about illness may believe they are being punished for wrongdoing or are victims of witchcraft or voodoo.They may be reticent to share information about curses with therapists.No data are present in the scenario to support delusions.Misdiagnosis more often labels a patient with depression as having schizophrenia.

Question 15

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?

Accepted Answer

Native Americans,because of their beliefs in the interrelatedness of parts and about being in harmony with nature,respond best to a holistic approach.No data are present to support dual diagnosis,because the patient has resolved the problem of excessive alcohol use.Psychopharmacological and somatic therapies may be part of the treatment,but the focus should be more holistic.Psychoanalysis is a long-term expensive therapy; cognitive therapy might be a better choice.

Question 16

To provide culturally competent care,the nurse should:

Accepted Answer

The correct answer is the most global response.Cultural competence requires ongoing effort.Culture is dynamic,diversified,and changing.The nurse must be prepared to gain cultural knowledge and determine nursing care measures that patients find acceptable and helpful.Interpreting the thinking of individual patients does not ensure culturally competent care.Reducing a patient's ethnocentrism may not be a desired outcome.

Question 17

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?

Accepted Answer

Persons of minority cultures value age and wisdom.Persons with a Western worldview tend to value youth.An older,mature registered nurse would be the most credible leader of this group.The nurse's size has no bearing on credibility.

Question 18

A nurse wants to engage an interpreter for a severely anxious 21-year-old male who immigrated to the United States two years ago.Of the four interpreters below who are available and fluent in the patient's language,which one should the nurse call?

Accepted Answer

A professional interpreter will be most effective because he/she will be able to interpret both language and culture.When an interpreter is engaged,the interpreter should be matched to the patient as closely as possible in gender,age,social status,and religion.Interpreters should not be relatives or friends of the patient.The stigma of mental illness may prevent the openness needed during the encounter.

Question 19

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:

Accepted Answer

Hispanic Americans and Native Americans traditionally treat time in a way unlike the Western culture.They tend to be present-oriented; that is,they value the current interaction more than what is to be done in the future.If engaged in an activity,for example,they may simply continue the activity and appear 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 patient's present orientation.

Question 20

Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups?

Accepted Answer

Directly confronting problems is a highly valued approach in the American culture but not part of many other cultures in which harmony and restraint are valued.American nurses sometimes mistakenly think that all patients should take direct action.Patients with other values will be unable to meet this culturally inappropriate outcome.Present orientation,interdependence,and a flexible perception of time are not valued in Western culture.These views are more predominant in other cultures.See relationship to audience response question.

Quiz 5: Cultural Implications for Psychiatric Mental Health Nursing