Question 1

A home health care nurse is visiting the home of a patient whose culture is totally unfamiliar to the nurse. What action by the nurse is best?

Accepted Answer

Nurses should observe family dynamics carefully, including communication, and try to copy them as much as possible. For instance, if the family does not make eye contact with the nurse, he/she should avoid trying to make direct eye contact with the family. The other options are reasonable, although telling the family you need to learn about their culture may place the burden of educating the nurse on them.

Question 2

A nurse is caring for a refugee patient who wants the community shaman to perform a healing ritual at the bedside. What action by the nurse is best?

Accepted Answer

Rituals are deeply powerful and have great meaning for individuals who practice them. The nurse should work with the patient to facilitate the ritual. Investigating the ritual for patient harm or illegality is ethnocentric; the nurse's first thoughts should not be on the potential negative aspects of a deeply meaningful activity. The patient has not requested the chaplain; offering to call the chaplain shows ethnocentrism and lack of respect for the patient. While working to facilitate the ritual, the nurse will discover if any aspect of it might be problematic and can collaborate with the patient and shaman to resolve the situation (e.g., if lighted candles are needed but prohibited by policy and fire code).

Question 3

The nurse is caring for a patient from a different cultural background. What action by the nurse best demonstrates cultural maintenance?

Accepted Answer

Cultural maintenance maintains and preserves relevant cultural care values pertaining to health care. Assisting the patient with a healing ritual important to him/her is an example. Teaching a heart-healthy diet and blood glucose monitoring falls into cultural care repatterning. Discussing what changes the patient is willing to accommodate is an example of cultural care accommodation.

Question 4

The nurse is caring for a patient from a culture that is unfamiliar. The patient nodded her head "yes" when asked if she will take her prescriptions as ordered, but the nurse discovers the patient does not take the medication but uses herbs for treatment. What action by the nurse is best?

Accepted Answer

Ethnocentrism is the belief that one's cultural beliefs are superior to others. To avoid practicing in an ethnocentric manner, the nurse needs to understand the meaning of the herbal preparation to the patient. Warning the patient of bad outcomes will not achieve the desired results if the herbs are culturally important and meaningful to her. Patient education is always important but is not the best answer because it does not allow the nurse to learn from the patient. Asking "why" question is a communication barrier likely to put the patient on the defensive.

Question 5

The student nurse learns that which item is the most important symbolic aspect of culture?

Accepted Answer

Language is the most extensively used set of symbols in a culture. The other items are important symbols but are not as important as language because words are used to represent objects and ideas.

Question 6

What does the nursing student learn about race?

Accepted Answer

Race is often thought to be inherited and biologically based, but this is not true. Race is a social construct that is used to group people together based on common physical characteristics, heredity, or common descent. People are placed into racial categories by the larger society. One race is not superior to any other.

Question 7

A student nurse is caring for a patient who is a refugee. The patient will take his own blood glucose readings and will self-administer a set dose of insulin but will not follow a sliding scale regimen in which the patient has to choose what dose of insulin to give. What action by the student nurse is best?

Accepted Answer

The patient may have a more fatalistic world view than is common in Western societies. The patient may follow "orders" from an authority figure but may feel like it is not his place to determine his insulin dose, or the patient may not feel competent in making that decision. Many explanations are possible. The student needs to determine what the patient feels related to this type of decision making before doing anything else.

Question 8

A patient in the emergency department needs an emergency operation. The patient refuses to consent and wants the nurse to call a respected elder in the community for consent. What action by the nurse is best?

Accepted Answer

In some cultures, decisions are made by men or community leaders. Although the patient may have the legal right to consent, if she comes from a culture in which gender and/or social roles do not permit decision making, she will likely refuse to consent. The best action is for the nurse to contact the elder and have him participate in the decision-making process per the patient's wishes. If the patient has given permission to share the information, doing so does not violate privacy laws. Admitting the patient without the operation does not help her medically.

Question 9

A nurse has been told he has many obvious stereotypes about a specific cultural group. What action by the nurse is best?

Accepted Answer

Stereotypes are fixed ideas, often unfavorable, about groups of people. They occur because of being unwilling to gather all the information needed to make fair determinations. The nurse would benefit most from beginning to learn about this cultural group. Caring or not caring for members of this group will not help him obtain new information. The nurse should not let stereotypes show, but this is not the best option.

Question 10

A nurse is caring for a homeless patient and tells the manager, "I will make sure he doesn't steal food from our nourishment center." What action by the manager is best?

Accepted Answer

This nurse is guilty of being prejudiced against the patient, who is a member of the homeless culture. Although hunger might drive a homeless person to steal, prejudice leads the nurse to believe that all homeless people steal. The manager informs the nurse of this information, gently pointing out the nurse's bias. A social work consultation may be a good idea for the patient but does not address the prejudiced nurse.

Question 11

A patient from an unfamiliar culture appears disinterested when the physician is telling her about options for treatment of a new diagnosis. After the physician leaves, the nurse attempts to talk to the patient and notices the same behavior. What action by the nurse is best?

Accepted Answer

Communication differences can lead to misunderstandings and possible medical errors. Many cultural groups have verbal and nonverbal communication patterns that differ from other groups. Variations can occur due to personal or social situations. The nurse should attempt to learn about the cultural group's communication patterns. Giving the patient written material and leaving the patient alone do not help solve this dilemma, and the patient may not have the literacy skills to understand the material. Asking the patient the meaning of behavior is unlikely to elicit useful information because the patient herself may not totally understand it or be able to articulate it. This may be a deeply seated cultural custom that is simply part of who the patient is.

Question 12

The new nurse tells the preceptor that since she is not prejudiced against ethnic minorities, they will not be discriminated against while in the hospital. What statement by the preceptor is most appropriate?

Accepted Answer

Discrimination can occur at the societal level, so even though this nurse is not prejudiced, patients from ethnic and cultural minorities can still suffer from discrimination. The other answers do not explain how discrimination can occur.

Question 13

The nurse is caring for a patient from a different culture. After assessing the patient and formulating the care plan, what action by the nurse is best?

Accepted Answer

Care plans, with their goals and interventions, should always be validated by the patient. This is especially true when the patient is from a different culture than the nurse. The charge nurse may or may not need to view the care plan, but after validation with the patient, the nurse can begin implementing the plan, including delegating appropriate tasks.

Question 14

A nursing student wants to observe enculturation practices of an ethnic minority community. What action by the student is best?

Accepted Answer

Enculturation is the process of passing a culture down from generation to generation. Culture can be taught directly, for instance, with the grandmother teaching the child. Culture can also be taught indirectly as when a child observes a role in the community. The student observing the grandmother teaching a child is the best example of enculturation.

Question 15

The nurse is working with a patient from an unfamiliar culture. After assessing the patient and the patient's cultural beliefs related to health care, what action by the nurse is best?

Accepted Answer

According to Leininger, the nurse should recheck assumptions and findings related to culture with the patient. This is an important step prior to creating a care plan. A standard plan will not be culturally congruent. The stem does not indicate that the patient has limited English, but if he did, using an interpreter would be important.

Question 16

A charge nurse works on an inpatient unit in a diverse city. To provide culturally congruent care to the patient, which action by the nurse would be most appropriate?

Accepted Answer

Nurses need to be cognizant of the impact of a patient's socioeconomic status to health care practices. The use of puns, sarcasm, and colloquialisms are not easily comprehended or interpreted by those who speak a different primary language. While the level of poverty in minority populations within all cultures is disproportionally higher, it is inappropriate to base an action on an assumption. According to research, some Hispanics believe that time is flexible and events will begin when they arrive. However, admonishment is not the best approach to dealing with this behavior.

Question 17

A nurse is working with a patient who has limited English proficiency. What action by the nurse is best?

Accepted Answer

Qualified interpreters should be utilized when working with non- or limited-English speaking persons. Using a family member to interpret can upset the balance of power within the family, cause embarrassment, and lead to inaccuracies. Using drawings and pictures or speaking in simple sentences is not as effective as using an interpreter.

Question 18

A patient refuses to take his blood pressure medication because "I feel totally fine and don't need it." What action should the nurse take first?

Accepted Answer

People with a present time orientation typically live in the "here and now" and may not see the benefit of adhering to medical regimens when they are not symptomatic. The nurse should assess the patient's time orientation. Documentation and education are both important but are not likely to secure the patient's cooperation.

Question 19

A new graduate nurse tells the manager that she does not believe she needs more in-service training on culturally congruent care because she already recognizes that there are significant differences among cultures to consider when providing care. What response by the manager is best?

Accepted Answer

Cultural sensitivity is the recognition that there are profound differences among cultures that can affect health care. But to provide culturally congruent care, the nurse must do more than just recognize these differences. This is an ongoing process. Option B is the only one that provides useful information to the nurse as to why she must continue to work on this aspect of her profession.

Question 20

A nursing faculty member is contrasting culture and ethnicity to students. Which statement is most accurate?

Accepted Answer

Culture refers to the learned, shared, and transmitted knowledge of values, beliefs, and ways of life of a group that generally are transmitted from one generation to another and influence the individual person's thinking, decisions, and actions in patterned or certain ways. Ethnicity is the person's identification with or membership in a racial, national, or cultural group and observation of the group's customs, beliefs, and language. The words may be used interchangeably by some people, but this is not correct.

Quiz 21: Ethnicity and Cultural Assessment