Chapter 4: Culture and Aging(FREE) My Nursing Test Banks

Chapter 4: Culture and Aging

Test Bank

MULTIPLE CHOICE

1. Which of the following is a true statement about gerontological nursing for patients of different races and ethnic backgrounds?

a.

The fact that a nurse is white has no bearing on the nurses ability to care for minority patients or patients of color.

b.

An encyclopedic accumulation of details of a particular culture is the best preparation for caring for persons from that culture.

c.

A nurse who works in Illinois does not need to be as concerned about sensitivity to multiple cultures as the nurse who works in California.

d.

Facial expressions, body language, posture, and touch are important elements of communication between a nurse and a patient from a different ethnicity.

ANS: D

Facial expressions, body language, posture, and touch become more important as language barriers limit the effectiveness of verbal exchanges. They also have different meanings in different cultures. A white person is more likely to have had opportunities and freedoms and take them for granted, whereas a person of color who has never experienced such opportunities and freedoms may regard them as special privileges. Knowledge of cultural details can be useful, but it can also lead to stereotypes that obscure the differences between individual persons. Illinois, along with California, Nevada, Florida, Texas, and New Jersey, is one of the states with the greatest numbers of immigrant older adults.

PTS:1DIF:UnderstandREF:2-3

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

2. Which of the following is a true statement about differing health belief systems?

a.

Personalistic or magicoreligious beliefs have been superseded in Western minds by biomedical principles.

b.

In most cultures, older adults are likely to treat themselves using traditional methods before turning to biomedical professionals.

c.

Ayurvedic medicine is another name for traditional Chinese medicine.

d.

The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system.

ANS: B

Older adults in most cultures usually have had experience with traditional methods that have worked as well as expected. After these treatments fail, older adults turn to the formal health care system. Even in the United States, it is not uncommon for older adults to pray for cures or wonder what they did to incur an illness as punishment. The Ayurvedic system is a naturalistic health belief system practiced in India and in some neighboring countries. This belief is characteristic of a holistic or naturalistic approach.

PTS:1DIF:UnderstandREF:7-8

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

3. Which of the following considerations is most likely to be true when working with an interpreter?

a.

An interpreter is never needed if the nurse speaks the same language as the patient.

b.

When working with interpreters, the nurse can use technical terms or metaphors.

c.

A patients young granddaughter who speaks fluent English would make the best interpreter because she is familiar with and loves the patient.

d.

The nurse should face the patient rather than the interpreter.

ANS: D

The nurse should face the patient rather than the interpreter is a true statement; the intent is to converse with the patient, not with a third party about the patient. Statement A is not true; reasons may prevent the patient from speaking directly to a nurse. Statement B is not true; technical terms and metaphors may be difficult or impossible to translate. Statement C is not true; cultural restrictions may prevent some topics from being spoken of to a grandparent or child.

PTS:1DIF:UnderstandREF:9-10

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

4. A resident in a nursing home insists that a priest hear his confession. The resident is very anxious, and the nursing home does not have a Roman Catholic chaplain. Which intervention should the nurse implement?

a.

An Episcopal priest is coming to visit the home this evening. Arrange an appointment with her for the resident.

b.

Report the residents change in behavior in detail so that the attending physician can appropriately prescribe medication.

c.

Refer the resident to the staff psychologist to address the underlying cause of the patients anxiety.

d.

Look in the local telephone book for a Roman Catholic Church, and ask the priest to visit the resident.

ANS: D

The nurse should respect the residents beliefs and practices and accommodate them when they are not harmful. Receiving the Sacrament can potentially relieve much of the patients anxiety. Arranging an appointment with an Episcopal priest for the resident is not an appropriate intervention; the two belief systems are not the same, and the resident is unlikely to experience the ministers efforts as satisfactory. Reporting the residents change in behavior to the attending physician is also inappropriate; the residents wish can be understood entirely within the residents belief system and need not reflect a medical problem, particularly if a visit by a priest relieves the residents anxiety. Referring the resident to the staff psychologist to address the underlying cause of the patients anxiety is an approach that attempts to change the residents belief system.

PTS: 1 DIF: Apply REF: 10-14 TOP: Caring

MSC: Psychosocial Integrity

5. Which of the following is most likely to be true about caring for an older African-American patient?

a.

The patient can expect to find support from his church after discharge.

b.

During a physical assessment, an examination of the interior of the patients mouth with adequate light is important.

c.

The patient may follow hot-cold beliefs.

d.

African Americans may avoid eye contact when interacting with others.

ANS: B

During a physical assessment, an examination of the interior of the patients mouth with adequate light is important; this statement is true because skin pigmentation can conceal some clinical signs such as cyanosis, which are more visible in the buccal cavity. Although the church is a source of support for many older African Americans, it should not be assumed at the expense of other forms of support. Traditional Chinese medicine is based on hot-cold beliefs, not African-American beliefs. Avoidance of eye contact has not been identified as a cultural practice for African Americans.

PTS: 1 DIF: Remember REF: 6-9 TOP: Caring

MSC: Safe, Effective Care Environment

6. An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health?

a.

Have the health care provider speak to him.

b.

Use principles of the holistic health system.

c.

Ask about his perceptions and treatment ideas.

d.

Consult with a practitioner of Chinese medicine.

ANS: C

Using the LEARN model (Listen with sympathy to the patients perception of the problem; Explain your perception of the problem; Acknowledge the differences and similarities; Recommend treatment; and Negotiate agreement), the nurse gathers information from the patient about cultural beliefs concerning health care and avoids stereotyping the patient. In the assessment, the nurse determines what the patient believes about caregiving, decision making, treatment, and other pertinent health-related information. Speaking with the health care provider is premature until the assessment is complete. Unless he accepts the beliefs, principles of the holistic health system can be potentially unsuitable and insulting for this patient. Unless he accepts the treatments, consulting with a practitioner of Chinese medicine can also be unsuitable and insulting for this patient.

PTS:1DIF:ApplyREF:50

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

7. Which action should the nurse take when addressing older adults?

a.

Speak in an exaggerated pitch.

b.

Use a lower quality of speech.

c.

Use endearing terms such as Honey.

d.

Speak clearly.

ANS: D

Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Providers should not assume all older adults are hearing or mentally impaired. The most appropriate action when addressing an older adult would be to speak clearly. Examples of unintentional ageism in language are exaggerated pitch, demeaning emotional tone, and a lower quality of speech.

PTS:1DIF:ApplyREF:4-6| 23 Text Box 4-3

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

8. The nurse prepares an older woman, who is Polish, for discharge through an interpreter and notes that she becomes tense during the instructions about elimination. Which intervention should the nurse implement?

a.

Move onto the discussion about medication.

b.

Ask the older woman how she feels about this topic.

c.

Instruct the interpreter to repeat the instructions.

d.

Have the older woman repeat the instructions for clarity.

ANS: B

When working with an interpreter, the nurse closely watches the older adult for nonverbal communication and emotion regarding a specific topic and therefore validates the assessment about the older adults tension before proceeding. Because the nurse notices her tension, the nurse temporarily suspends the preparation to validate her assessment. If the nurse proceeds and the older adult is uncomfortable discussing elimination, then important instructions can be missed, leading to adverse effects for the older adult. Repeating the instructions can aggravate the older adults discomfort. Instructing the older adult to repeat the nurses instruction ignores the her needs.

PTS:1DIF:ApplyREF:9-10

TOP:Communication and Documentation

MSC: Safe, Effective Care Environment

9. The nurse is aware that cultural competence means having the skills to put cultural knowledge to use in all of the following except:

a.

Assessment

c.

Intervention

b.

Communication

d.

Collaboration

ANS: A

Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. To provide culturally competent care, the nurse gathers data about the culture, the older adult, and the specific cultures impact on the older adult, organizes the data, and applies the information by planning, implementing, and evaluating nursing care. Planning includes supporting cultural patterns. Assessing includes increasing cultural knowledge. Through increased knowledge, nurses can better assess the strengths and weaknesses of the older adult within the context of their culture and know when and how to effectively intervene to support rather than hinder cultural patterns that enhance wellness and coping.

PTS: 1 DIF: Analyze REF: 4 TOP: Caring

MSC: Safe, Effective Care Environment

10. The health care provider discusses the need for surgery with an older adult and her family. Which information about the older adults culture is important for the nurse to collect before this discussion to facilitate the process of informed consent?

a.

Attitudes about caregiving

c.

Rituals for death and dying

b.

Process of decision making

d.

Experience with discomfort

ANS: B

The nurse uses knowledge of the cultures influence on the older adult in relation to decision making to avoid unnecessary tension and misunderstanding and thus to facilitate the process of informed consent. The nurse uses the information about decision making by sharing the cultural information with the health care provider and by addressing the culturally suitable member of the family for informed consent. Caregiving is unrelated to the process of informed consent. Death and dying, although potentially relevant, is unrelated to informed consent. Relevant to surgical procedures, the older adult and family experiences with pain and discomfort are important to the pain management plan.

PTS:1DIF:ApplyREF:6

TOP:Communication and Documentation

MSC:Health Promotion and Maintenance

11. The nurse plans care for an older African American adult who is from Jamaica and resides in New York City. Which should the nurse include in planning care?

a.

Attribute his illness to breaking a voodoo.

b.

Help him improve social relationships.

c.

Maintain blood pressure below 120/70 mm Hg.

d.

Review the principles of the magicoreligious system.

ANS: C

Because African Americans tend to be at risk for cardiovascular disease and hypertension, the nurse plans to maintain the patients blood pressure at or below the current recommendation by the American Heart Association. The nurse can be incorrectly assuming that he practices and believes in the magicoreligious system. The nurse should assess his spiritual beliefs and determine how much they influence his attitudes toward Western health care. The magicoreligious system maintains social relationships in good condition to prevent illness; however, if the older adult does not follow this cultural practice, then this goal can be unsuitable. The older adult may not believe in this system; therefore the information can be irrelevant.

PTS:1DIF:ApplyREF:21 Text Box 4-1

TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment

12. Which health belief system uses treatments to repair a body part?

a.

Holistic

c.

Personalistic

b.

Biomedical

d.

Magicoreligious

ANS: B

Because dysfunction or a structural abnormality is thought to cause disease, the biomedical system believes in repairing the structural abnormality. The holistic system holds that health is attained through balance. The personalistic system uses treatments such as meditation, fasting, and praying. The magicoreligious system is the same as the personalistic system.

PTS:1DIF:UnderstandREF:7

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

13. An older individual from which culture is likely to receive more respect than a younger person in the same community?

a.

Canadian

c.

German

b.

Anglo-Saxon

d.

African American

ANS: D

An African American is more likely to receive respect than a younger person in the same community because African Americans are more likely to value the wisdom and insight of older adults. Older individuals from a Euro-American culture are less likely to be valued by the community, owing to the effects of the industrial revolution and the need for strong, young laborers. An individual who is an Anglo-Saxon has European ancestry. A German citizen is European.

PTS:1DIF:UnderstandREF:5

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

14. Which cultural group is more likely to distrust the health care system than other cultural groups in the United States?

a.

African Americans

c.

Mexican Americans

b.

Chinese Americans

d.

Lebanese Americans

ANS: A

Because of a history that includes slavery, social injustice, and abuse of African-American men in medical research, African Americans are more likely to distrust the health care system in the United States. Chinese are less likely to distrust the health care system of the United States than African Americans because of a lack of a history of major health-related injustices. Mexican Americans are less likely to distrust the health care system of the United States because of the many benefits they receive that are unavailable in Mexico. Lebanese Americans are less likely to distrust the health care system of the United States because of a lack of a history of health-related injustices against their culture in the United States.

PTS:1DIF:UnderstandREF:5

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. The nurse is assessing an older adult from a culture different than the nurses by asking questions from the Explanatory Model for Culturally Sensitive Assessment. Which question(s) should the nurse ask to follow this model? (Select all that apply.)

a.

How can we negotiate to solve the problem?

b.

What treatment can improve your condition?

c.

Should we try my plan first to see if it helps?

d.

Can we discuss differences in our plans now?

e.

How long have you experienced the problem?

f.

Who, other than me, can make you feel better?

ANS: B, E, F

Asking about potential therapies is a question from the Explanatory Model and asks what the individual believes will help clear up the problem. The nurse asks about the duration of the problem as a part of applying the Explanatory Model. The nurse asks about other disciplines that the individual believes can be therapeutic. This question is based on the LEARN Model.

PTS:1DIF:ApplyREF:25 Text Box 4-5

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

2. A nurse caring for older adults must be aware of which consequences of ageism in language? (Select all that apply.)

a.

Reduced sense of self

c.

Lowered self-esteem

b.

Poor nutritional intake

d.

Decreased memory performance

ANS: A, C, D

Some health professionals demonstrate ageism, in part because providers tend to see many frail, older persons, and fewer of those who are healthy and active. Consequences of ageism have been identified as a reduced sense of self, lowered self-esteem, lowered sense of self-competence, and decreased memory performance. Poor nutritional intake has not been identified as a consequence.

PTS:1DIF:ApplyREF:4-6| 23 Text Box 4-3

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

3. Which factor(s) are associated with the provision of culturally competent care? (Select all that apply.)

a.

Cultural awareness

c.

Cultural skills

b.

Cultural knowledge

d.

Cultural connections

ANS: A, B

As nurses move toward cultural competence, they increase their cultural awareness, knowledge, and skills. Cultural competence means having the skills to put cultural knowledge to use in assessment, communication, negotiation, and intervention. Cultural connections have not been identified as a factor.

PTS:1DIF:ApplyREF:4-6

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

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