Question 1

In a small, rural hospital the nurse is caring for a patient who speaks a language other than English. The nurse needs to use an interpreter to communicate but the hospital does not have access to an interpreter who speaks the patients language. When choosing another individual to interpret for this patient, what characteristic should the nurse prioritize?

Accepted Answer

Cultural needs should be considered when choosing an interpreter; for instance, fluency in varied dialects is beneficial. In choosing an interpreter, you do not want one who speaks in an excessively loud voice, conducts the conversation too quickly, or avoids repetition.

Question 2

You are a community health nurse who provides care to a group of Hispanic people living in an area that is predominantly populated by Caucasian people. How would you characterize the Hispanic people in this community?

Accepted Answer

The term minority refers to a group of people whose physical and cultural characteristics differ from the majority of people in a society. There are four generally identified minority groups: Blacks/African Americans, Hispanics, Asian/Pacific Islanders, and Native Americans. Such groups are not referred to as exceptions or underclasses. A subgroup is a division of a group that is in some way distinguished from the larger group.

Question 3

A nurse is caring for an elderly woman who predominantly identifies with an East Asian culture. How can the nurse best demonstrate an awareness of culturally congruent care?

Accepted Answer

Establishment of an environment of culturally congruent care and respect begins with effective communication, which occurs not only through words, but also through body language and other cues, such as voice, tone, and loudness. Not all cultures are comfortable with eye contact. Unless you are fluent in the patients native language, trying to communicate in that language would not be effective communication. Not all cultures incorporate touch while communicating.

Question 4

An emergency department nurse is preparing to inspect and palpate the head and scalp of an older adult who experienced a fall. A member of which group would most likely consider this examination as a violation of norms?

Accepted Answer

For many Asian Americans, it is impolite to touch the patients head because the spirit is believed to reside in the head. Therefore, assessment of the head or evaluation of a head injury requires permission of the patient, or a family member if the patient is not able to give permission. This is not the case with the other listed groups.

Question 5

The nurse is helping a patient choose her menu options for the following day. The nurse reads out the option of ham with scalloped potatoes and the patient states that her religion does not allow this. Which of the following is most likely the patients religion?

Accepted Answer

Many Islamic people abstain from eating pork. Members of other religions also proscribe the consumption of meat in general, or pork in particular, but the other listed religions are not among these.

Question 6

The nurse is preparing a discharge teaching session with an Asian patient to evaluate the patients ability to change a dressing. The patient speaks and understands minimal English. What would be the best way to promote understanding during the teaching session?

Accepted Answer

Policies that promote culturally competent care establish flexible regulations pertaining to visitors (number, frequency, and length of visits), provide translation services for nonEnglish-speaking patients, and train staff to provide care for patients with different cultural values. Writing instructions, having the patient demonstrate the procedure, and asking the patient to repeat instructions do not adequately compensate for the communication barrier that exists.

Question 7

You are the nurse caring for a patient who is a recent immigrant to the United States from Mexico. Which of the following variables would you prioritize when performing an assessment of the patients cultural beliefs?

Accepted Answer

Assessment of a patients culture should include the patients country of origin, language (communication style), food preferences or restrictions, health maintenance practices, and religious preferences and practices. This aspect of assessment does not explicitly include the patients support systems, marital status, or age, though each of these parameters would be assessed at different points.

Question 8

You are caring for a patient who is terminally ill whose family has requested to hold a spiritual ceremony during which they will be using incense. What would be the best intervention you could make on behalf of this patient?

Accepted Answer

Culturally competent policies are developed to promote an environment in which the traditional healing, spiritual, and religious practices of patients are respected and encouraged and to recognize the special dietary practices of patients from selected cultural groups. To promote spirituality and transcultural nursing, the nurse should make or help to make the arrangements. The nurse should not attempt to dissuade the family or to relegate the ceremony to a site outside the hospital.

Question 9

A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects. The nurses behavior is an example of what?

Accepted Answer

The nurses behavior is an example of cultural imposition, defined as the tendency to impose ones cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.

Question 10

An infant with a diagnosis of pyelonephritis is receiving care on the pediatric unit and the nurses review of the childs electronic health record reveals that the infant has not received any of her scheduled immunizations. The mother informs the nurse that immunizations are against her cultural beliefs, and she does not want her child to receive immunizations. In this scenario, what do the mothers views on immunizations represent?

Accepted Answer

Immunizations in this scenario are a cultural taboo. Cultural taboos are defined as activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is defined as the tendency to impose ones cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies.

Question 11

In planning the nursing care of a patient who lives with chronic pain, the nurse has included the intervention of therapeutic touch. When categorizing this particular complementary therapy, the nurse should identify it as which of the following?

Accepted Answer

Therapeutic touch is an example of an energy therapy. Biologically based therapies include herbal therapies, special diet therapies, orthomolecular therapies, and biologic therapies. Mind-body interventions include meditation, dance, music, art therapy, prayer, and mental healing. Manipulative and body-based methods include chiropractic, massage therapy, osteopathic manipulation, and reflexology. The other options are incorrect because they are not examples of energy therapy.

Question 12

You are admitting a patient who is a recent immigrant from China and who has a diagnosis of adenocarcinoma. During the patients admission assessment, the patient speaks of her beliefs related to health care and indirectly references the yin/yang theory. Based on her cancer diagnosis and her yin/yang beliefs, which meal will the patient most likely order for lunch?

Accepted Answer

Foods are classified as cold (yin) and hot (yang) in the naturalistic or holistic perspective. In this theory, foods are transformed into yin and yang energy when metabolized by the body. Hot foods are eaten when a person has a cold illness such a cancer, headache, stomach cramps, and a cold. Based on this information, the patient would select chicken noodle soup with crackers, fruit crisp, and hot tea as these are hot foods. The other options are cold foods and are eaten when a patient has a hot illness such as a fever, rash, sore throat, ulcer, or infection.

Question 13

The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes to the unit. During the initial assessment, the patient informs the nurse that he has been seeking assistance and care from the shaman in his community. The nurse recognizes that the patients blood pressure and his blood sugar level are elevated upon admission. What is the nurses best response to the patients indication that his care provider is a shaman?

Accepted Answer

Native American patients may seek assistance from a shaman or medicine man or woman. The nurses best approach is not to disregard the patients belief in folk healers or try to undermine trust in the healers. Nurses should make an effort to accommodate the patients beliefs while also advocating the treatment proposed by health science. The nurses best response incorporating these strategies is, I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may improve your blood pressure and blood sugar levels.

Question 14

The nurse is providing care for an older adult patient who has a diagnosis of shingles. The nurse is aware that this health problem is attributable to the varicella zoster virus. This belief is an example of which paradigm explaining the cause of disease and illness?

Accepted Answer

The biomedical or scientific perspective assumes that all events in life have a cause and effect and that all of reality can be observed and measured. One example of the biomedical or scientific view is the bacterial or viral explanation of communicable diseases. The naturalistic or holistic view states that forces of nature must be kept in natural balance or harmony. Factual is not a recognized category of beliefs.

Question 15

In your role as a community health nurse, you are focusing your current health promotion efforts on diseases that are disproportionately represented among ethnic and racial minorities. Which of the following diseases would you likely address? Select all that apply.

Accepted Answer

Ethnic and racial minorities are disproportionately burdened with cancer, heart disease, diabetes, human immunodeficiency virus (HIV), infection/acquired immunodeficiency syndrome (AIDS), and other conditions. COPD and Alzheimers disease are incorrect because health care disparities have not been noted with these two diseases.

Question 16

Prior to planning health promotion interventions in your local community, you are appraising the key health care indicators in your region and comparing them with those in the nation as a whole. What do these key indicators reveal about the United States?

Accepted Answer

Key health indicators in the United States reveal a significant gap in health status between the overall American population and people of specific ethnic backgrounds. Option B is incorrect because key health care indicators do not show a gap in health care delivery between the overall population and subgroups of minority populations; options $\mathrm{C}$ and $\mathrm{D}$ are incorrect because these ethnic populations are not singled out in these ways.

Question 17

You are planning an educational inservice for your nursing colleagues with the goal of fostering culturally competent care. What outcome should you prioritize when planning this education?

Accepted Answer

The concept of culturally competent care applies to health care institutions, which must develop culturally sensitive policies and provide a climate that fosters the provision of culturally competent care by nurses. Nurses must learn to acknowledge and adapt to diversity among their colleagues in the workplace. This is not necessarily dependent on nurses examining their own cultures. Because patients needs vary widely, care is not equal. Evaluating cultural awareness in others does not necessarily enhance ones own cultural competence.

Question 18

The nurse assessing health disparities in the community is focusing on disparities that exist apart from those between ethnic groups. In which of the following groups are these disparities most evident?

Accepted Answer

Health disparities are noted among women, gays and lesbians, and people with disabilities. Specific health disparities have not been found among men, the middle-aged, or single people.

Question 19

You are performing a cultural nursing assessment of a newly admitted patient of Cuban descent. What would you include in your assessment? Select all that apply.

Accepted Answer

Cultural nursing assessment refers to a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. Subgroups are not a specific focus of this assessment.

Question 20

The quality improvement team at a large, urban hospital has recognized the need to better integrate the principles of transcultural nursing into patient care. When explaining the concept of transcultural nursing to uninitiated nurses, how should the team members describe it?

Accepted Answer

Transcultural nursing, a term sometimes used interchangeably with cross-cultural, intercultural, or multicultural nursing, refers to research-focused practice that focuses on patient-centered, culturally competent nursing. It is not limited to language barriers and foreign-born patients. It does not focus solely on health risks and benefits in ethnic groups.

Quiz 7: Overview of Transcultural Nursing