Chapter 10: Illness, Culture, and Caring: Impact on Patients, Families, and Nurses My Nursing Test Banks

Chapter 10: Illness, Culture, and Caring: Impact on Patients, Families, and Nurses

Test Bank

MULTIPLE CHOICE

1. Which illness has the characteristics of an acute illness?

a.

Exercise-induced asthma

b.

Type 2 diabetes

c.

Influenza

d.

Cleft palate

ANS: C

Feedback

A

Exercise-induced asthma is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

B

Type 2 diabetes is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

C

Influenza symptoms are short-lived, and the person returns to his or her previous level of wellness.

D

Cleft palate is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

DIF: Cognitive Level: Comprehension REF: p. 195

2. Which illness has the characteristics of a chronic illness?

a.

Lupus

b.

Bronchitis

c.

Chicken Pox

d.

Gastroenteritis

ANS: A

Feedback

A

Lupus requires long-term treatment and impacts a person for his or her entire life. Previously, the life expectancy was as short as a few months after diagnosis.

B

Bronchitis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

C

Chicken pox is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

D

Gastroenteritis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

DIF: Cognitive Level: Comprehension REF: p. 195

3. Which statement about acute illness is true?

a.

Most people with acute illness develop chronic illness.

b.

Most people with acute illness return to their previous level of wellness.

c.

All people with an acute illness need medical care.

d.

Acute illnesses are usually catastrophic in nature.

ANS: B

Feedback

A

Some people do go on to develop a chronic illness after an acute one, but unless there are complications, most people with acute illness return to their previous level of wellness.

B

Most people with acute illness return to their previous level of wellness.

C

Many acute illnesses do not require medical intervention.

D

While some acute illnesses are catastrophic in nature, not all acute illnesses are.

DIF: Cognitive Level: Knowledge REF: p. 195

4. What is the primary difference between acute illness and chronic illness?

a.

In acute illness, symptoms begin suddenly, progress quickly, and subside quickly.

b.

In acute illness, symptoms begin suddenly, progress gradually, and do not subside.

c.

In chronic illness, symptoms begin gradually, progress suddenly, and subside quickly.

d.

In chronic illness, symptoms begin suddenly, require ongoing management, and subside quickly.

ANS: A

Feedback

A

Acute illness is defined as severe symptoms that appear suddenly, progress steadily, and subside quickly.

B

Chronic illness symptoms progress gradually and generally do not subside.

C

Chronic illness symptoms progress gradually and generally do not subside.

D

Chronic illness symptoms begin gradually.

DIF: Cognitive Level: Comprehension REF: p. 196 | Box 10-1

5. A patient with diabetes who refuses to change eating patterns may be in which stage of adjustment?

a.

Denial and disbelief

b.

Irritability and anger

c.

Attempting to gain control

d.

Acceptance and participation

ANS: A

Feedback

A

Denial and disbelief is the first stage in adjustment to an illness. It is characterized by belief that the symptoms do not really represent illness and will go away.

B

Irritability and anger are characteristics of the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger displaced onto others.

C

The person in the attempting to gain control stage usually seeks help and knowledge as ways to gain control.

D

The acceptance and participation stage occurs when the patient is ready to participate in decisions about treatment.

DIF: Cognitive Level: Comprehension REF: p. 197

6. A patient states, I am so upset that I need a knee replacement. I should have done those exercises that the physical therapist told me to do years ago. In which stage of illness is the patient?

a.

Disbelief and denial

b.

Irritability and anger

c.

Attempting to gain control

d.

Depression and despair

ANS: B

Feedback

A

The person in the disbelief and denial stage believes that the symptoms do not really represent illness and will go away.

B

Irritability and anger is the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger at self or others.

C

The person in the attempting to gain control stage usually seeks help and knowledge as ways to gain control.

D

At the depression and despair stage, the patient may experience many losses, and depression is the response.

DIF: Cognitive Level: Comprehension REF: p. 197

7. A patient states, I do not understand why I keep getting these headaches. I have seen a nurse practitioner and two specialists. I have taken several medications, but the headaches keep coming back. In which stage of illness is the patient?

a.

Disbelief and denial

b.

Irritability and anger

c.

Attempting to gain control

d.

Acceptance and participation

ANS: C

Feedback

A

The person in the first stage believes that the symptoms do not really represent illness and will go away.

B

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

C

Attempting to gain control is the third stage in adjustment to an illness. The person in this stage usually seeks help and knowledge as ways to gain control.

D

The fifth stage occurs when the patient is ready to participate in decisions about treatment.

DIF: Cognitive Level: Comprehension REF: p. 197

8. A patient states, There is no hope. Theyre going to keep me here until I die. Cant you give me my medication more often? Im going to die anyway. In which stage of illness is this patient?

a.

Disbelief and denial

b.

Irritability and anger

c.

Attempting to gain control

d.

Depression and grief

ANS: D

Feedback

A

The person in the first stage believes that the symptoms do not really represent illness and will go away.

B

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

C

The person in the third stage usually seeks help and knowledge as ways to gain control.

D

Depression and grief is the fourth stage in the adjustment to an illness. The person at this stage may experience many losses, and depression is the response.

DIF: Cognitive Level: Comprehension REF: p. 197

9. A patient states, I have knowledge about my diet and how to do my insulin injections, so I can get on with my life. In which stage of illness is this patient?

a.

Disbelief and denial

b.

Irritability and anger

c.

Attempting to gain control

d.

Acceptance and participation

ANS: D

Feedback

A

The person in the first stage believes that the symptoms do not really represent illness and will go away.

B

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

C

The person in the third stage usually seeks help and knowledge as ways to gain control.

D

Acceptance and participation is the final stage in the adjustment to an illness. A person in this stage is ready to participate in decisions about treatment.

DIF: Cognitive Level: Comprehension REF: p. 197

10. A contemporary view of the sick role includes

a.

patient as partner with the health care provider.

b.

patient as submissive to the health care provider.

c.

patient noncompliant with the health care provider.

d.

moving away from cultural values when making health care decisions.

ANS: A

Feedback

A

A contemporary view of the sick role includes partnering with patients in making health care decisions.

B

Patient as submissive to health care provider is a paternalistic perspective.

C

Patients are expected to want to get well, and the patient who wants to get well will comply with the prescribed treatment.

D

All health care needs to be culturally sensitive.

DIF: Cognitive Level: Comprehension REF: p. 198

11. A patient tells the nurse, Ill let you do whatever you think is best for me. The patient does very little independently without calling for assistance. The nurses conclude that the patient is demonstrating which personality characteristic?

a.

Acceptance

b.

Sense of control

c.

Coping

d.

Dependence

ANS: D

Feedback

A

The person demonstrating acceptance will acknowledge the situation.

B

The person demonstrating sense of control would be actively seeking ways to manage the situation.

C

The person who is coping is looking to decrease the threat in the situation or to increase his or her resources to deal with the threat.

D

Some people assume a passive attitude and rely on others to care for them. This can occur with or without illness.

DIF: Cognitive Level: Comprehension REF: p. 199

12. A patient diagnosed with breast cancer responded by gathering information about treatment options and becoming involved in a self-help group. The nurse assesses that the patient is demonstrating which personality characteristic?

a.

Independence

b.

Hardiness

c.

Self-control

d.

Tolerance

ANS: B

Feedback

A

Independence is not requiring or needing to rely on someone else.

B

Hardiness is the ability to feel capable of handling stressful life events. Hardy people are likely to perceive themselves as having some control over a situation even when they are ill.

C

Self-control is the ability to manage oneself in the situation.

D

Tolerance is the capacity to endure or adapt to a situation.

DIF: Cognitive Level: Application REF: p. 210

13. A patient was diagnosed with ovarian cancer 5 years ago. She underwent chemotherapy and radiotherapy, but cancer returned 2 years ago with metastases to the bone and possibly the lung. She says the cancer is no longer curable, but treatable. During this time the patients daughter was critically injured in a car accident and now lives with a traumatic brain injury, needing round-the-clock care. Her husband had an affair. She continues to work and volunteers with various community groups. Which phenomenon is the patient demonstrating?

a.

Resourcefulness

b.

Independence

c.

Acceptance

d.

Resilience

ANS: D

Feedback

A

The patient has not demonstrated that her ability to continue work and activities is due to her use of resources.

B

Independence is not requiring or needing to rely on someone else.

C

Acceptance means the person acknowledges the situation for what it is.

D

Resilience is the successful adaptation despite challenging or threatening circumstances. The patient has faced difficult, adverse, and traumatic events in her life but continues to participate and contribute.

DIF: Cognitive Level: Comprehension REF: p. 200

14. A patient in whom metastatic cancer is diagnosed tells the nurse, God has never let me down before. Ill pray for strength. This patients illness behavior is being influenced by

a.

resiliency.

b.

sense of control.

c.

spirituality.

d.

depression.

ANS: C

Feedback

A

Resiliency is survival under trying circumstances.

B

Sense of control is feeling that one can control a situation.

C

Spirituality is an inner strength related to a belief in and connectedness to a higher power.

D

Depression involves feelings of loss, grief, and despair.

DIF: Cognitive Level: Application REF: p. 200

15. A patient in whom cancer has just been diagnosed tells the nurse, Just get out of here and leave me alone! Let me suffer alone. God is punishing me. The nurse determines that the most appropriate nursing diagnosis for this patient is

a.

risk for loneliness.

b.

powerlessness.

c.

dysfunctional grieving.

d.

spiritual distress.

ANS: D

Feedback

A

The risk for loneliness is when a person may experience a vague sense of unpleasantness.

B

Powerlessness is a perceived lack of control in the current situation. This patient may feel powerless, but the reference to Gods punishment makes spiritual distress a more likely diagnosis.

C

Dysfunctional grieving is the unsuccessful use of intellectual and emotional responses to deal with a loss.

D

Spiritual distress is the inability to experience and integrate meaning and purpose in life through connectedness with self, others, or a power greater than oneself.

DIF: Cognitive Level: Application REF: p. 201

16. Which of the following is an appropriate intervention for the nursing diagnosis of spiritual distress?

a.

Never pray with patients or share readings that can have a religious connection.

b.

Inform patients of the prevalent religious beliefs that exist in the locale where they are being treated.

c.

Consider patients religious beliefs when planning care.

d.

Reassure patients that they should not blame God for their illness.

ANS: C

Feedback

A

It is acceptable to pray with patients or share readings with them if requested by the patient and the nurse is comfortable doing so.

B

The nurse should help the patient to tap into his or her own spirituality, not create one for them or influence the patient.

C

Helping patients engage spiritually assures holistic care.

D

Nurses should recognize that blaming God is a sign of spiritual distress.

DIF: Cognitive Level: Comprehension REF: p. 201

17. A patient is in the intensive care unit after a myocardial infarction and refuses to stay in bed, saying, I have to be up and walking around. When I stayed in bed after having my babies 40 years ago, I got so weak I could hardly move. This patients illness behavior is being influenced by

a.

hardiness.

b.

past experiences.

c.

culture.

d.

role expectations.

ANS: B

Feedback

A

Hardiness is the resistance to stressful events.

B

The patient is basing what she thinks she needs to do on experiences she had 40 years ago after she had delivered her children.

C

She does not say she bases her need to get up on cultural beliefs.

D

She does not base her need to be up on an expectation that she should be.

DIF: Cognitive Level: Application REF: p. 202

18. A Caucasian nurse is caring for a Native American after a stroke. The nurse finds the patient sleeping while holding several small feathers bound by a beaded leather thong. The nurse should consider the possibility that this is

a.

an interesting trinket to brighten the environment.

b.

a gift from his grandchildren to make him feel closer to the family.

c.

an important item used in native healing practices.

d.

an item that might introduce microorganisms into the hospital environment.

ANS: C

Feedback

A

Although the objects meaning is unknown, the implication is that it is not important.

B

Although the objects meaning is unknown, the implication is that it is not important.

C

Because the patient is of a different culture than the nurse, the nurse should clarify with either the patient or family what the meaning and importance of the item is and how it should be treated.

D

Although the objects meaning is unknown, the implication is that it is not important.

DIF: Cognitive Level: Application REF: p. 203

19. A young girl from a Middle Eastern country is in the process of dying. Her parents ask the nurses to allow her to be prepared for death by being dressed in a specific garment and headdress every day. The parents cannot be there every day to do this and ask the nurses to apply the attire. Which actions by the nurses demonstrate culturally competent care?

a.

Allowing the parents to dress the patient in the garment and headdress when they are by her side

b.

Consulting the chaplain as to the meaning of the ritual in the Middle East

c.

Informing the parents that hospital policy requires all patients to wear hospital garments

d.

Learning how to apply the garment and headdress properly

ANS: D

Feedback

A

Allowing the parents to dress the child when they are by her side does not assure the daily cultural expectations of the family.

B

While the meaning of the ritual would be nice to know, whether the nurses know the meaning does not make the ritual any less culturally important to the family.

C

Informing the parents that hospital policy requires all patients to wear hospital garments totally disregards the desires of the family.

D

By learning how to dress the patient, the nurses are acknowledging the importance of culture for this family.

DIF: Cognitive Level: Application REF: p. 206

20. An English-speaking nurse gave a nonEnglish-speaking Asian patient instructions about preparing an abdominal surgical site. The nurse showed the patient how the bottle of povidone-iodine was to be used in cleansing the area. The patient smiled and nodded throughout the instructions. The patient did not respond when asked if he had any questions. When the nurse left the room, the patient promptly drank the bottle of povidone-iodine. Which action would be most effective in preventing this error?

a.

Giving the patient written instructions in his language

b.

Using a medical interpreter to give the preoperative instructions

c.

Having the patient sign a statement that he understood the instructions

d.

Using illustrations to show the patient the procedure

ANS: B

Feedback

A

The patient may not be able to read in his language but may not indicate that to the nurse.

B

The use of the interpreter assures that the patient has received the correct information in a manner he can understand.

C

Having the patient sign a statement does not indicate that he understood. He may sign because he feels that this is expected.

D

Although illustrations may help, the use of an interpreter is still the best action to ensure understanding.

DIF: Cognitive Level: Analysis REF: p. 206

21. Why is a basic understanding of ethnopharmacology part of being a culturally competent nurse?

a.

Significant differences among ethnic groups have been found in relation to the effects of medications.

b.

Ethnopharmacology is a new area of study important to all nurses.

c.

Nurses should know how medications may affect individual patients to properly administer the medication.

d.

Pharmacology is a significant aspect of nursing practice.

ANS: A

Feedback

A

The absorption, metabolism, distribution, and elimination of medications have been demonstrated to differ among ethnic groups. Nurses need to be aware of these ethnic differences to provide quality care.

B

The importance is not that it is new, but that ethnopharmacology is significant to the care nurses provide.

C

Although nurses should know how to administer medication properly to any patient, the nurse also needs to understand the different responses including those based on ethnicity.

D

Although the understanding of pharmacology is significant, the nurse needs to understand ethnopharmacology to be culturally competent.

DIF: Cognitive Level: Comprehension REF: p. 204

22. The best definition of ethnocentrism is

a.

a tendency to compare the behavior of others with your own cultural values.

b.

an astute awareness of your own personal biases regarding other cultures.

c.

a tendency to view your own culture as superior to others.

d.

the ability to incorporate patients cultural beliefs and values into health teaching.

ANS: C

Feedback

A

A tendency to compare the behavior of others with ones own cultural beliefs describes cultural relativism.

B

Ethnocentrism implies a lack of awareness of ones own biases.

C

Ethnocentrism describes a tendency to view your own culture as superior to others.

D

The ability to incorporate patients cultural beliefs and values into health teaching describes culturally sensitive care, not ethnocentrism.

DIF: Cognitive Level: Comprehension REF: p. 204

23. The nurse finds a patient sitting in bed, rocking back and forth, wringing her hands and repeating rapidly, I cant breathe. My heart is pounding. I think Im going to die. Her physician is called to the bedside and tells the nurse, She is having an anxiety attack. What assessment can be made by the nurse?

a.

Severe anxiety is present in this patient.

b.

Cultural factors control anxiety levels.

c.

Focusing on discharge instruction will ease the anxiety.

d.

The level of anxiety cannot be determined at this point.

ANS: A

Feedback

A

With increased anxiety, one observes rapid speech, increased purposeless body movements, and subjective statements of discomfort.

B

Although cultural factors may influence how anxiety is expressed, they do not control anxiety.

C

If a person is experiencing anxiety, he or she will not be able to focus on receiving information, including discharge instructions.

D

The level of anxiety can be determined on the basis of the observation of the patients behavior.

DIF: Cognitive Level: Application REF: p. 209 | Box 10-5

24. A patient has been diagnosed with angina. As he talks with the nurse, he asks several good questions about angina and seems able to concentrate on the explanations. He seems eager to learn how to manage his condition. What assessment can be made by the nurse?

a.

Severe anxiety is present.

b.

Mild anxiety is present.

c.

Moderate anxiety is present.

d.

The level of anxiety cannot be determined.

ANS: B

Feedback

A

When severe anxiety is present, the persons thoughts are scattered and attention to learning is decreased.

B

With mild anxiety, the person is able to focus attention, and there is an increased capacity for learning.

C

When moderate anxiety is present, the person is only able to concentrate on one thing at a time and would not be asking questions.

D

The level of anxiety can be determined from the patients behaviors.

DIF: Cognitive Level: Application REF: p. 209 | Box 10-5

25. Nurses can best help patients deal with stress by

a.

helping patients eliminate all stress from their lives.

b.

helping patients communicate their stress better to friends and family.

c.

helping patients evaluate their lifestyles for areas of potential stress.

d.

intervening in the family system to reduce family stress.

ANS: C

Feedback

A

It is not possible or desirable to eliminate all stress from ones life.

B

Having someone to talk to may be helpful in reducing stress, but problem solving and planning are more effective plans for management.

C

Nurses can assist patients to restructure the stressful aspects of their lives to reduce or minimize stress.

D

It is not reasonable to expect the nurse to solve the patients problems.

DIF: Cognitive Level: Comprehension REF: p. 211

26. When planning for patient teaching, the nurse is aware that which of the following factors create(s) a barrier to learning?

a.

Mild anxiety

b.

Pain and fatigue

c.

Family presence

d.

Patient autonomy

ANS: B

Feedback

A

Mild anxiety can improve learning.

B

Pain and fatigue create barriers to learning.

C

Family presence does not necessarily impede learning.

D

Patient autonomy does not impede learning, and patient learning facilitates development of autonomy.

DIF: Cognitive Level: Knowledge REF: p. 212 | Box 10-9

27. The parents of a 4-year-old diabetic have become increasingly argumentative especially about whether the father helps enough with child care and housekeeping. He works two jobs which leaves little time to help his stay-at-home wife. Which nursing intervention is most appropriate for this family?

a.

Referring the parents to a marriage counselor

b.

Discussing with the parents the stresses they perceive in the situation

c.

Suggesting that the father give up one of his jobs

d.

Identifying a way to reallocate the childs diabetes care between the parents

ANS: B

Feedback

A

It may be premature to refer the parents to a marriage counselor until the situation is assessed further.

B

Before changes are suggested and/or made, everyone involved should have identified what the perceived stressors are for all members of the family.

C

Suggesting that the father give up his part-time job may be premature until it is known what the stressors are, as well as determining whether the income is required to provide for the needs of the family.

D

The nurse should not be the one determining how to reallocate the childs care within the family. The decision rests with the parents.

DIF: Cognitive Level: Application REF: p. 212

MULTIPLE RESPONSE

1. Which questions will aid the nurse in planning culturally congruent care? (Select all that apply.)

a.

What do smiles, nods, and hand gestures mean?

b.

How are you usually addressed?

c.

How many health care professionals have you seen?

d.

What is eaten when one is sick?

e.

Who is involved in making decisions about health care?

ANS: A, B, D, E

Feedback

Correct

The questions allow the nurse to learn about the specific cultural expectations of the patient.

Incorrect

While it is important to know how many providers the patient has been seeing, this information is not related to culturally competent care.

DIF: Cognitive Level: Comprehension REF: p. 206

2. A patient recently lost a job as a salesperson. Which behaviors would indicate that the patient is experiencing stress? (Select all that apply.)

a.

Patient describes the desire to sleep a great deal due to fatigue.

b.

Patient states a decrease in participating in usual church activities.

c.

Patient seems to have difficulty selecting items from a menu.

d.

Patient is reading the newspaper and online job listings daily.

e.

Patient continues to spend time with her dog at the dog park.

ANS: A, B, C

Feedback

Correct

Excessive sleepiness/fatigue, decrease in social activities and participation in usual events, and difficulty making decisions are correct because stress affects a person physically, emotionally, and cognitively.

Incorrect

Reading the job listings and spending time with the dog at the park indicate the patient is managing the situation.

DIF: Cognitive Level: Comprehension REF: p. 210

3. Which of the following are characteristic of compassion fatigue? (Select all that apply.)

a.

Increased energy

b.

Burnout

c.

Being prone to accidents

d.

Poor judgment

e.

Increased interest in reflection

ANS: B, C, D

Feedback

Correct

Loss of physical energy, burnout, accident proneness, emotional breakdowns, apathy, indifference, poor judgment, and disinterest in introspection are all signs of compassion fatigue.

Incorrect

Increased energy and increased interest in reflection are not signs of compassion fatigue.

DIF: Cognitive Level: Comprehension REF: p. 215

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