Chapter 08: Culture, Ethnicity, and Spirituality My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 08: Culture, Ethnicity, and Spirituality

Test Bank

MULTIPLE CHOICE

1. To include a cultural focus in patient care planning, which belief about faith will the nurse incorporate? Faith is a:

a.

Belief of body and mind

b.

Manner of expressing spirituality

c.

Use of spiritual resources without empiric proof

d.

Search for the sacred, transcendent, or universal

ANS: C

Faith is the ability to draw on spiritual resources without having physical and empiric proof. Body and mind refer to psychosomatic concepts. A manner of expressing spirituality refers to religion. A search for the sacred, transcendent, or universal refers to spirituality.

DIF: Cognitive Level: Comprehension REF: Page 151

TOP: Nursing Process: Assessment (Learning and Teaching)

MSC: NCLEX: Psychosocial Integrity

2. A culturally diverse patient refuses to participate in a group because of the presence of a person who can put spells on. The nurse recognizes a priority need to explore this patients:

a.

Economic status

b.

Home environment

c.

Health-illness beliefs

d.

Educational background

ANS: C

Culture influences beliefs about health and illness, including causes of illness. What the nurse might label as delusional might be a culturally determined belief about illness causation. The other assessments do not relate to the situation as directly.

DIF: Cognitive Level: Application REF: Page 143

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

3. An Asian-American patient diagnosed with depression explains to the nurse that eating two specific foods will restore the balance of hot and cold and she will be cured. The nurse should:

a.

Explain that foods cannot cure mental disorders.

b.

Arrange for the patient to talk with the dietitian.

c.

Change the subject to focus on medication compliance.

d.

Accept that cultural beliefs about illness die slowly.

ANS: B

Culturally determined beliefs about health and illness should be respected. If there are no contraindications to the patient eating the foods mentioned, the nurse should facilitate obtaining them. Attempt to explain the flaw in the patients belief is an attempt to negate culturally determined beliefs. Changing the subject does not address patient concerns. Assuming that the belief is inflexible suggests the patients beliefs have no merit.

DIF: Cognitive Level: Application REF: Page 160

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

4. When working with a patient newly emigrated from Asia who has been assessed as having xenophobia, the nurse could anticipate making the assessment that the individual:

a.

Resists sharing food with others

b.

Would be reluctant to ride an elevator

c.

Is unlikely to talk with nonfamily members

d.

Fears the consequences of going out of doors

ANS: C

Xenophobia is defined as a morbid fear of strangers. The xenophobic individual would not necessarily resist sharing food (fear of germs), riding in elevators (fear of closed spaces), or going out of doors (fear of open spaces).

DIF: Cognitive Level: Application REF: Page 146

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

5. The nurse plans to use pamphlets to teach a newly immigrated Vietnamese patient about diabetes mellitus. Before initiating this education, the priority information for the nurse to obtain is the patients:

a.

Ability to read and understand English

b.

Readiness and ability to learn this material

c.

Previous knowledge and interest in the subject

d.

Willingness to participate and follow instructions

ANS: A

Pamphlets are useful only if the patient can read and understand the language in which the material is written. The other options are secondary to this priority concern.

DIF: Cognitive Level: Analysis REF: Pages 147-148

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

6. A nurse is planning to incorporate a culturally sensitive focus in her nursing care. Which of these underlying principles concerning cultural heritage will be included?

a.

A group is formed from among individuals who share similar ancestral origins.

b.

A condition of belonging to a group is that all members share a unique heritage.

c.

Learned patterns of behavior and thinking are shared by members of a cultural group.

d.

The classification of humans into cultural groups is generally based on physical characteristics.

ANS: C

Cultural heritage is learned patterns of behavior and thinking shared by a particular group that is transmitted over time to other members. Ancestral origins, a similar heritage, and physical characteristics may be shared traits but alone do not constitute cultural heritage.

DIF: Cognitive Level: Comprehension REF: Page 143

TOP: Nursing Process: Teaching and Learning

MSC: NCLEX: Psychosocial Integrity

7. A patient diagnosed with paranoid schizophrenia is describing religiously-based delusions that other patients find offensive. Which nursing intervention will the nurse implement to provide a therapeutic milieu?

a.

Engaging the delusional patient in prayer in order to redirect the problematic behavior

b.

Explaining to the delusional patient that such talk is offensive to some of the milieu and will not be allowed

c.

Asking for the pastoral counselor to visit the unit and talk with both the delusional patient as well as the rest of the milieu

d.

Removing the delusional patient from the milieu when staff is unable to successfully refocus the conversation to a non-religious topic

ANS: C

Occasionally, individuals with serious mental disorders experience delusions that are spiritual or religious in nature. Certified pastoral counselors are skilled with regard to counseling patients and consulting with staff about these problems, and they assist the health care team in ways that address the particular concerns of individual patients. Challenging or debating the truth of a persons delusions is not therapeutic, and spiritual delusions are no exception. Engaging in spiritual or religious practice with individuals on a psychiatric unit is also inappropriate. Removing the patient from the milieu is seldom therapeutic and done only to maximize milieu safety.

DIF: Cognitive Level: Application REF: Page 152

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

8. A patient confides to the nurse that she feels guilty about the poor relationship she had with her mother-in-law, who is now deceased. The patient tells the nurse that she is sure God will punish her for this and that she needs to confess her sins to someone. Which of the following is the best response by the nurse?

a.

Would you like to speak to the chaplain when he comes later today? In the meantime, we could talk about your relationship with your mother-in-law.

b.

It sounds as if you need to talk about this. Lets sit down in a private area. Id like to know more about your relationship with your mother-in-law.

c.

We all have trouble with our in-laws occasionally. God doesnt punish us for that.

d.

Whats done is done. We need to focus on your positive qualities.

ANS: A

The patient has identified a specific spiritual problem that a chaplain would be equipped to handle, so a referral is appropriate. The nurse, in the meantime, is equipped to discuss relationship issues. Offering to talk about the relationship without addressing the patients expressed spiritual needs is not therapeutic. Suggesting that the patients relationship issues are not uncommon minimizes the patients feelings. Attempting to refocus the patient dismisses the patients needs.

DIF: Cognitive Level: Application REF: Page 152

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

9. A patient is dealing with the loss of a spouse. Which response shows an understanding of the role spirituality plays in the management of grief?

a.

Hes in a better place; my faith tells me that is true.

b.

I find that my faith is stronger now that Im alone.

c.

Im told that a sense of spiritual connection will help me go on with life.

d.

My faith helps me deal and gives me renewed hope; I rely on it to help me heal.

ANS: D

Spirituality allows one to cope with these feelings by providing a sense of hope and meaning to experiences that would otherwise be crippling. Spirituality is often a key component in the healing process, and it is an integral part of the patients treatment plan. The remaining options do not as directly deal with the patients personal loss and the progression to healing.

DIF: Cognitive Level: Application REF: Page 151 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

10. The nurse identifies a patient as being in spiritual distress. Which patient statement supports this nursing diagnosis?

a.

Ive never felt so alone before in my entire life.

b.

I dont know if I could get through this without faith in God.

c.

Ive always relied on my faith in God but now I feel Ive been abandoned.

d.

Why do bad things happen to good people? Ive always been a good person.

ANS: C

Spiritual distress is a nursing diagnosis that is defined as a disruption in the value and belief systems that pervades the persons state of being and that transcends the physical and psychosocial self. Feeling abandoned when one has always relied on faith is an indication of spiritual distress. Feeling alone and questioning why something has occurred is not necessarily spirit based, and not an indication of spiritual distress. Questioning ones ability to manage an emotion without ones faith is a testimony to the faith, not an expression of despair.

DIF: Cognitive Level: Application REF: Pages 151-152

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

11. Assessment of interpersonal relationships of Asian and Asian-American patients is dependent on the nurses understanding that the culture of these patients is identified as high context and will therefore value:

a.

Privacy; family is not routinely included in health discussions

b.

Their right to make independent decisions about their care

c.

Sharing their opinions and wishes with healthcare team

d.

Their role and place in their family structure

ANS: D

Asian and Asian-American patients have been socialized into high-context cultures in which there is collective identity, group decision making, emotional dependence, deference to those of higher status and age, and use of indirect language to communicate. The remaining options are characteristic of low-context cultures.

DIF: Cognitive Level: Application REF: Page 149

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

12. Which communication behavior would be considered uncharacteristic for a patient from a high-context culture?

a.

Little direct eye contact

b.

Use of global messages

c.

Use of nonverbal symbolization

d.

Arguing points with the physician

ANS: D

Arguing to get a point across is more characteristic of the communication of a person from a low-context culture. A person from a high-context culture would not be expected to dispute a person with authority. The person from a high-context culture would be expected to use global communication and nonverbal symbolization but to make little direct eye contact.

DIF: Cognitive Level: Application REF: Page 149

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

13. An Asian-American patient is referred to the mental health clinic. He has many somatic complaints for which no physical basis has been found. The patient tells the nurse that he does not believe this clinic can help him. Based on knowledge of the beliefs common to this culture, what can the nurse hypothesize about the patient?

a.

Because of the cultural stigma attached to mental illness, he may be expressing psychological distress via somatic symptoms.

b.

Acculturation has occurred because feelings of hopelessness are alien to his native culture.

c.

Suicide is not a present danger because suicidal impulses are rarely associated with feelings of helplessness among Asian-American patients.

d.

The patient has rejected both family care and traditional healing methods in favor of health care practices of the new culture.

ANS: A

The following facts are known about beliefs commonly held by members of this culture: there is a stigma attached to mental illness; mental illness is often described in somatic terms; members of this culture come into treatment late and often have feelings of hopelessness upon entry into the system; families tend to care for their members with mental illness; and traditional healing has usually been tried and failed before the patient attempts to access the mental health system.

DIF: Cognitive Level: Application REF: Page 156

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

14. The nurse determines which patient is at the greatest risk for a spiritual crisis?

a.

A patient, whose religion opposes the use of blood products, has a severely bleeding ulcer

b.

A single parent who must decide to terminate life support for a terminally ill child

c.

A newlywed whose spouse has died in an automobile accident caused by a drunk driver

d.

A patient who denies the need for spiritual support when given the diagnosis of terminal cancer

ANS: A

A spiritual crisis may occur when religious or spiritual beliefs conflict with a necessary procedure or a treatment protocol, such as permitting a blood transfusion. Although the remaining options all present with a serious emotional situation, there is no evidence to support that the patients beliefs are being challenged.

DIF: Cognitive Level: Application REF: Page 151

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

15. The nurse believes that a patient is exhibiting internal locus of control related to spiritual development. Which patient statement supports this conclusion?

a.

Praying gives me tremendous comfort.

b.

I pray because my church says that prayer is the way to God

c.

I will ask that my fellow church members pray for me to get better.

d.

My mother prayed daily and she was such a good and kind person.

ANS: A

During development, ones sense of faith, meaning moral values, and judgment moves from an external locus of control to an internal locus of control. An example of such internal control is the expressed feeling of comfort derived from prayer. The remaining options reflect external locus of control since each is an expression of how beliefs about prayer are provided by others; church doctrine and the faith of others.

DIF: Cognitive Level: Application REF: Pages 153-154

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

16. A novice nurse has identified impaired verbal communication for an older Asian patient who recently immigrated to the United States based on the patients reluctance to maintain eye contact and engage in a conversation with staff. In order to assure that the diagnosis is appropriate, the nurse manage asks:

a.

Have you asked the patient why communication is difficult for them?

b.

Could you be misdiagnosing common shyness for a communication issue?

c.

Have you noticed the patient communicating differently with family when they visit?

d.

Do you think the patients cultural traditions have a part to play in their communication behaviors?

ANS: D

Misunderstanding occurs when the nurse fails to take into account culture-specific interaction patterns. Silence, infrequent eye contact, shame, fear, and language barriers all affect a patients ability to interact. In light of the patients cultural diversity, the other options are less likely to be pertinent.

DIF: Cognitive Level: Application REF: Page 149 | Page 163

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

17. As a nurse assesses culture factors with patients, the subculture that poses the greatest risk to a patients mental health is:

a.

Poverty

b.

Female gender

c.

Advanced age

d.

Cultural ethnicity

ANS: A

Many people in poverty suffer discrimination and stigma which places them at risk for depression and other anxiety-related illnesses. The other subcultures do not present with the same or greater degree of risk.

DIF: Cognitive Level: Application REF: Page 144

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

MULTIPLE RESPONSE

1. The nurse is addressing the possibility that a family of newly emigrated Hispanics may experience cultural shock. Which statements are truisms concerning this cultural adaptation issue? Select all that apply.

a.

Most primitive cultures embrace the lifestyle of the industrialized ones.

b.

It may take generations for family members to become acculturated.

c.

The most resistant to adaptation are children and young adults.

d.

Typical responses include fear and distrust of strangers.

e.

Family members are at high risk for anxiety disorder.

ANS: B, E

Many immigrants experience culture shock, a sudden or violent disturbance of emotions that involves a sense of anxiety, fear, and distrust. Children and young adults usually adapt to their new surroundings more quickly. It takes approximately three generations or longer for members of a minority group to integrate into the dominant cultural environment.

DIF: Cognitive Level: Application REF: Page 143

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

2. A nurse works in a mental health clinic serving many Southeast Asian individuals. Which statements by the nurse would validate a striving toward cultural competence? Select all that apply.

a.

Its a challenge to plan treatment that is culturally congruent.

b.

My dream is to be accepted by the Southeast Asian patients I care for.

c.

There is so much to learn about the Southeast Asians and their problems.

d.

Psychiatric care tends to be similar for those of Southeast Asian cultures.

e.

I always try to be sensitive to the uniqueness of my culturally diverse patients.

ANS: A, B, C, E

Culturally competent health care requires the development of interpersonal skills, communication skills, and awareness and sensitivity to the uniqueness of individuals. It is also an ongoing process, because each new encounter presents the opportunity to gain additional knowledge and skills. Psychiatric care should be tailored to the individual and not to cultural stereotypes.

DIF: Cognitive Level: Application REF: Page 147 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

3. A patients cultural background is identified as being sociologically low context. Which nursing interventions would be appropriate for such a patient? Select all that apply.

a.

Asking the patient to contribute suggestions to include in the care plan

b.

Providing the patient with privacy during visits with their religious leaders

c.

Instructing the patient on how to select foods within their prescribed diet plan

d.

Waiting to provide medication education until family members are visiting

e.

Facilitating the family in assuming responsibility for the patients physical needs

ANS: A, B, C

Behaviors and communication styles of cultural societies referred to as low context (individualistic) are those in which people care for themselves. Low-context societies emphasize thinking and values that are centered on the individual: autonomy, individual initiative, the right to privacy, and emotional independence. Facilitating family in assuming responsibility for the patients physical and educational needs is not compatible with the characteristic needs of the low-context society.

DIF: Cognitive Level: Application REF: Pages 148-149

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

4. Guidelines for communicating with a patient whose ability to speak and understand English is questionable include (select all that apply):

a.

Use interpreters whenever possible.

b.

Allow sufficient time for patient to formulate response.

c.

Recruit a family member as an interpreter whenever possible.

d.

Use nonverbal communication whenever it is considered appropriate.

e.

Maintain eye contract if such interaction is accepted by the patients culture.

ANS: A, B, D, E

Interpreters are preferred to translators since they are trained to decode the message behind the patients verbal response. The patient needs time to formulate their responses especially if they are attempting to speak in English. Nonverbal communication is a good source of information when effectively interpreted. Eye contact when accepted by the patients culture encourages interaction and allows for interpretation of nonverbal communication. Family members should not be used if other options are available since they are not always objective in their translations.

DIF: Cognitive Level: Application REF: Page 150 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

5. A patient experiencing depression over the loss of a loved one shares that, Im not a religious person but I need something to help me cope with this. The nurse shows an understanding to the need for an outlet for the expression of emotions when (select all that apply):

a.

Asking, Does dancing make you feel good?

b.

Encouraging the patient to talk about the feelings

c.

Offering to arrange for a consult with the music therapist

d.

Asking, Can you think of ways to express your emotions in a healthy way?

e.

Suggesting the patient draw a picture of what it feels like to experience such a loss

ANS: A, C, E

Religious practices are often beneficial for patients, but for those who do not have a formal religion, other spiritual interventions are useful. Group therapies that encourage patients to extend themselves and to find meaning in life are helpful. In addition, several other creative forms of expression such as art, music, and dance therapy often address patients spiritual needs. Although the other options are not inappropriate, they do not provide interventions but rather reflect assessment questions.

DIF: Cognitive Level: Application REF: Page 152

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

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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