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?

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.No data are present to support a diagnosis of posttraumatic stress disorder.Psychoanalysis is a long-term therapy that is very expensive.Cognitive therapy might be a better choice.

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:

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.Cognitive therapy or medication would not be a treatment suggested by a patient with an Eastern worldview.Someone from an indigenous culture may suggest rituals.

Question 3

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 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?

Accepted Answer

Somatization is common in this culture and demonstrates the patient's psychological pain.The distracters do not give the nurse helpful guidance.

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:

Accepted Answer

An English-speaking nurse who does not speak the other language cannot accurately assess a person who is mixing English with another native language.Accurate assessment data is vital;hence,calling for an interpreter is necessary and expedient.Hospitals have access to individuals who are fluent in various languages.Deferring the interview should not be an initial option.Data do not suggest the patient is aggressive,although dramatic gestures may be interpreted as aggression in some cultural contexts.

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:

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 7

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 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?

Accepted Answer

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.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.Crossing the leg to show the bottom of the foot is considered impolite in some cultures.Turning away suggests distancing.Crossing the arms over the chest may be perceived as a "closed" authoritarian posture.

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?

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 culturally diverse patients are seen in the clinic,reviewing cultural differences in patients' responses to these medications is helpful and vital to patient safety.One such difference is the development of extrapyramidal side effects at lower drug doses in Asian patients.The distracters would not be the nurse's initial actions.

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:

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 commonly labels a patient with depression as having schizophrenia.

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?

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 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?

Accepted Answer

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.

Question 13

Which communication style would be most effective 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,a more passive style described would be best received.The other options would be more effective to use with patients of a Western orientation.

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?

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 15

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.

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?

Accepted Answer

Native Americans frequently use spiritual healers and herbs and a holistic approach to treating the person-mind,body,and spirit.Many Native Americans prefer to use their own spiritual healers from their own tribes.It is inappropriate to deny the patient's experience or expose other patients to the patient's visions.Leaving a patient who may be experiencing command hallucinations alone is dangerous.

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.

Accepted Answer

The nurse needs to make sure that any herbs the patient may take are not harmful when taken in conjunction with the prescribed antidepressants.Patients adhere to their own belief systems,so admonishing the patient not to take herbals will not be effective.

Question 18

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

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:

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

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:

Accepted Answer

The patient is experiencing normal grief symptoms.The Hispanic culture reports hearing and seeing their deceased loved ones,especially during times of stress.This is not the same as hallucinating.Losing 5 pounds in 6 months is not a significant weight loss after such a life-changing event.

Quiz 6: Cultural Implications for Psychiatric Mental Health Nursing