Chapter 7: Social, Cultural, and Spiritual Context of Psychiatric Nursing Care My Nursing Test Banks

Chapter 7: Social, Cultural, and Spiritual Context of Psychiatric Nursing Care

Test Bank

MULTIPLE CHOICE

1. Sociocultural risk factors are identified by assessing which patient characteristic?

a.

Belief system

b.

Daily health habits

c.

Stress management habits

d.

Restfulness of the home environment

ANS: A

Six patient characteristics, influenced by social norms, cultural values, and spiritual beliefs, are known to act as risk factors. These are patient age, ethnicity, gender, education, income, and beliefs. The remaining options are representative of protective factors.

DIF: Cognitive Level: Comprehension REF: Text Page: 100

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

2. Which of these statements by a nurse suggests that the nurse will display cultural sensitivity when interviewing a patient from a different culture?

a.

The patients cultural background is very different from my own.

b.

I think introducing ethnic humor is an effective way of establishing rapport.

c.

I have to remember to document the patients ethnic origin and religion in the record.

d.

Before the interview I will take a few minutes to review actions that might offend a patient of this culture.

ANS: D

The nurse should use established references in order to be familiar with specific patient cultures. Simple actions, gestures, and attitudinal displays that are part of the nurses culture may be offensive to a patient of a different culture. Understanding this indicates that the nurse will make an effort to display cultural sensitivity.

DIF: Cognitive Level: Application REF: Text Page: 99

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

3. Which statement will be most important for planning future community mental health services?

a.

The population over age 65 years will continue to increase.

b.

Many more people will move out of rural and into urban areas.

c.

The U.S. population will increase drastically by the year 2050.

d.

The U.S. population will become more diverse with regard to race and ethnicity.

ANS: D

By 2050, Hispanics will make up about 25% of the U.S. population; African Americans will make up about 14%, Asians and Pacific Islanders about 8%, and whites about 53%. Although the other options relate to community population, they are very general in regard to population size and not specific to issues pertaining to mental health education.

DIF: Cognitive Level: Comprehension REF: Text Page: 100

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

4. A nurse working with individuals from ethnic minority groups recognizes which as a factor that affects mental health care?

a.

They often delay seeking help until problems become intense or chronic.

b.

They characteristically do not engage in early termination from care.

c.

They tend to dislike using community support systems.

d.

They tend to avoid using family support systems.

ANS: A

Research suggests that members of minority groups delay seeking help until their problems are intense, chronic, and at a stage that is difficult to treat, and until community and family support systems have been exhausted. Delays in accessing care and early termination from care create a cyclical reliance on more costly health care services.

DIF: Cognitive Level: Comprehension REF: Text Page: 101

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

5. When conducting an admission interview, a mental health nurse asks a patient a series of questions related to personal beliefs. When the patient asks why these questions are being asked, how should the nurse respond?

a.

These questions are routine and are a mandatory part of the admission process.

b.

The prime reason is that these questions help the staff to identify any specific health care practices that would conflict with your religious beliefs.

c.

Mental health can be affected by personal belief systems, so it is important that your treatment plan be developed to be compatible with your beliefs.

d.

These questions are asked of every patient and are confidential, but if you are not comfortable answering them I will simply note that in your chart.

ANS: C

A persons belief system, worldview, religion, or spirituality can have a positive or negative effect on mental health. Belief systems play a vital role in determining whether a particular explanation and associated treatment plan will have meaning for the patient and others in the patients social network. Declaring that something is routine/mandatory does not address the patients question nor does ensuring confidentiality. Addressing religious beliefs is only a partial focus of the interview process.

DIF: Cognitive Level: Application REF: Text Page: 103

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

6. A nurse working in a mental health center would determine which patient to be the best candidate for a spirituality-based 12-step intervention program?

a.

A patient who has generalized anxiety disorder

b.

A patient who has an addiction to alcohol

c.

A patient with a personality disorder

d.

A patient who has agoraphobia

ANS: B

Spirituality-based intervention programs, such as 12-step programs, which encourage the individual to surrender control to an external supreme being, are commonly used treatments for addictive disorders, including addiction to alcohol.

DIF: Cognitive Level: Application REF: Text Page: 103

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. A student nurse asks an instructor, Since most of the patients on the unit are female, does that mean that women experience more mental illness than men? The instructor replies:

a.

Thats a very astute observation. Youre right.

b.

The prevalence is relatively the same for men and women.

c.

As a matter of fact, mental illness is more prevalent among men.

d.

Im sure that you will be able to find that information in your textbook.

ANS: B

Although there appear to be distinctive male and female patterns of risk, when all psychiatric disorders are included, the prevalence of mental illness among males and females is roughly equal. Correcting the students misconception immediately would be more beneficial than assuming the student will acquire the information. The two remaining options present incorrect information.

DIF: Cognitive Level: Comprehension REF: Text Page: 101

TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity

8. During a team conference about a patient, the patients spouse states, My spouse is Irish, so I should have expected a drinking problem. This statement is an example of:

a.

racism.

b.

intolerance.

c.

stereotyping.

d.

discrimination.

ANS: C

Stereotypes are depersonalized conceptions of individuals within a group. Racism is a prejudice originating out of bias toward a particular racial group. Intolerance is an attitude of not accepting or respecting different opinions, practices, or people, whereas discrimination is unfair treatment of a person or group on the basis of prejudice.

DIF: Cognitive Level: Comprehension REF: Text Page: 104

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

9. One task of an administrator of a culturally sensitive mental health system would be to:

a.

eliminate all staff bias related to cultural diversity.

b.

hire significant numbers of minority health care providers.

c.

incorporate the values of culture competency into all levels of care.

d.

keep access to care open for the dominant ethnic, social, and religious groups.

ANS: C

Incorporating the value of culture into all levels of care is desirable. Eliminating all staff bias is unlikely, hiring significant numbers of minority health care providers is not appropriate or realistic, and keeping access to care open for minority groups would be an act that is independent of cultural sensitivity.

DIF: Cognitive Level: Application REF: Text Page: 106

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

10. Asian patients prescribed psychiatric medications:

a.

exhibit better response to antidepressants and phenothiazine than do African-American patients.

b.

have less tendency to abuse alcohol with their medications than do white patients.

c.

have extrapyramidal side effects at lower dosage levels than do other ethnic groups.

d.

experience fewer side effects when taking anticholinergic medications than do white patients taking the same dosage.

ANS: C

The occurrence of extrapyramidal side effects among Asians is the only statement about racial/ethnic psychobiological differences listed that is accurate.

DIF: Cognitive Level: Comprehension REF: Text Page: 108

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

11. Which intervention will the nurse consider to be a central responsibility when planning for culturally competent treatment?

a.

Learn what the illness means to the patient and how the patients beliefs can help mediate the stressors.

b.

Learn as much as possible regarding the beliefs of both the patient and the patients extended family.

c.

Ask the patient about beliefs in a formal organized religion and daily or weekly religious practices that can be factored into treatment.

d.

Tell the patient that it will be important to examine together the belief systems of both the nurse and patient to be sure that they are congruent.

ANS: A

In terms of treatment planning, the psychiatric nurse needs to be sensitive to sociocultural issues but also must transcend them. A central responsibility of the nurse is to understand what the illness means to the patient and the way in which the patients beliefs can help to mediate the stressful events or make them easier to bear by redefining them as opportunities for personal growth.

DIF: Cognitive Level: Application REF: Text Page: 103

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

12. With regard to sociocultural risk factors, nursing care should be based on the premise that:

a.

risk for individual development of a psychiatric disorder usually remains constant over time.

b.

all members of ethnic groups have the same risk for developing a psychiatric disorder.

c.

risk factors interact constantly, so different factors become important at different times.

d.

sociocultural risk factors affect assessment and nursing care planning more than implementation of care.

ANS: C

Risk factors interact constantly, so risk factors may assume greater or lesser significance for an individual over time. Cultural group members vary in terms of risk for specific mental health disorders, and sociocultural risk factors affect the nurse working with the patient during all phases of the nursing process.

DIF: Cognitive Level: Comprehension REF: Text Page: 100

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

13. An elderly Hispanic woman has become depressed after the death of her husband. The nurse would anticipate that this patient is most likely to:

a.

be less able to adapt than before.

b.

recover and return to her preillness state.

c.

believe the death is a punishment for past acts.

d.

suffer recurrences of depression because of cultural strain.

ANS: B

It has been found that as age increases, the prevalence of depression decreases. Older people have a greater capacity to adapt and tend to recover from depression more quickly than younger individuals; they are also less likely to have a recurrence.

DIF: Cognitive Level: Application REF: Text Pages: 103-104

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

14. A nurse assessing sociocultural risk factors for a 34-year-old female, single, poorly educated immigrant with three young children and who receives support from social services, should be most concerned about the effects of:

a.

age.

b.

gender.

c.

immigration.

d.

disadvantagement.

ANS: D

Disadvantagement factors, such as lack of basic resources and low education level, create profound problems in prevention, diagnosis, and treatment of psychiatric disorders.

DIF: Cognitive Level: Application REF: Text Page: 104

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

15. A 32-year-old Caucasian female college graduate who weighs 150 pounds is heavily sedated by the amount of lorazepam (Ativan) prescribed for anxiety reduction. A Hispanic male heavy laborer who is the same age and weight as the female patient has taken the same dose of Ativan and states that his anxiety is barely under control. What factor most likely accounts for this difference?

a.

The male is Hispanic, whereas the female is Caucasian.

b.

Social stratification and poverty make treatment more difficult.

c.

Men more often underrate the efficacy of antianxiety medication.

d.

The female gastrointestinal system more readily absorbs benzodiazepines.

ANS: D

The difference is gender-based. The lesser amount of stomach acid secreted by women means that benzodiazepines are better absorbed.

DIF: Cognitive Level: Analysis REF: Text Page: 108

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

16. Two patients, an African-American agnostic man and a Caucasian Baptist woman, are both diagnosed with schizophrenia, paranoid type. Both patients are 42 years old and live at the poverty level. The age of onset for the illness was 21 years in the male patient and 41 years in the female patient. What sociocultural factor accounts for the male patients less favorable prognosis?

a.

His religious belief system

b.

Caucasian Americans are more amenable to treatment.

c.

Males living in poverty receive less social support than women living in poverty.

d.

He had an earlier onset of illness that has resulted in his longer course of illness.

ANS: D

Males tend to have earlier onset of schizophrenia than females. The mean age of onset is 31 years for males and 41 years for females. Age of onset is a critical factor in the prognosis for schizophrenia because early onset is associated with a longer course of illness and poorer prognosis. It is also known that women have a better response to both pharmacological and psychosocial treatments. Religious beliefs are not known to have a negative impact on the prognosis of schizophrenia. No available research supports the idea that Americans are less amenable to treatment or that males receive less social support than females when both live in poverty.

DIF: Cognitive Level: Analysis REF: Text Pages: 100-102

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. A culturally competent nurse possesses which characteristics? (Select all that apply.)

a.

Flexibility

b.

An unbiased nature

c.

Sensitivity to diversity

d.

Willingness to learn

e.

Mastery of nursing skills

ANS: A, B, C, D

Cultural competency requires sensitivity to differences and a willingness to learn about cultural beliefs and practices. These characteristics need to be joined with an unbiased ability to move past traditional methods and demonstrate a willingness to change. Skills mastery is not directly related to cultural competency.

DIF: Cognitive Level: Comprehension REF: Text Page: 99

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

2. Which factor is most likely to delay a member of a minority group from seeking needed medical care? (Select all that apply.)

a.

Access to medical insurance

b.

Ability to speak English as a second language

c.

Availability of primary physicians for referrals

d.

Amount of support provided by ethnic community

e.

Familiarity of the community where care is being offered

ANS: A, B, C

Although community support and familiarity are factors in general health care attitudes and practices, they usually do not negatively affect the decision to seek medical assistance as much as the remaining options do. Lack of insurance, low access to primary physicians for referral, and language barriers that make it difficult to negotiate an unfamiliar system are factors that promote a delay in seeking help.

DIF: Cognitive Level: Application REF: Text Pages: 100-101

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

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