Question 1

The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?

Accepted Answer

Cytochrome P-450 enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates. Information about medication is important but does not apply to pharmacokinetics.

Question 2

A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with these consumers?

Accepted Answer

Relationships are based on the idea that the Supreme Being is present in each person and that all persons must be valued and treated with dignity. This is particularly true of treatment received by tribal elders, healers, and others perceived to be in positions of importance. The other options are not consistent with the ecologic worldview.

Question 3

Culture is defined as a group's shared:

Accepted Answer

Culture is the internal and external manifestation of a person's, group's, or community's learned and shared values, beliefs, and norms that are used to help individuals function in life and understand and interpret life occurrences. None of the other responses provides an adequate explanation of culture, because all are too narrow in scope.

Question 4

A Hispanic patient reports symptoms consistent with the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with:

Accepted Answer

The patient is probably experiencing lost soul, a culture-bound illness. Its symptoms are depressive in nature and might well respond to treatment with an antidepressant. However, because the individual sees the cause as loss of the soul, she will not have faith in medication as a cure. Using a traditional healer to return the lost soul will set the stage for medication to relieve symptoms. The other options are not culturally appropriate.

Question 5

A Hispanic patient says, "I have no energy and cannot eat. I want to sleep but can't, because pain moves around different parts of my body." A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing:

Accepted Answer

Loss of one's soul, a culture-bound illness occasionally seen among Hispanic individuals, produces vague symptoms such as those described. Western medicine regards these as depressive symptoms, but individuals with lost soul speak only of physical symptoms, rather than psychological or emotional disequilibrium. The other options are culture-bound disorders with symptoms different from what is described in this scenario.

Question 6

A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which action should occur next?

Accepted Answer

Many Asians and Asian-Americans believe that questioning an authority figure (nurse) would be disrespectful, so they do not ask for clarification when they do not understand directions for their treatment. Individuals of this culture are usually willing to comply once they understand. Written information may be provided later. Although hot and cold foods might be used by Asian-Americans, there is no evidence that this patient is interested in this therapy.

Question 7

An African-American patient tells a nurse with a European-American worldview, "There's no sense talking. You wouldn't understand because you live in a white world." Select the nurse's best response.

Accepted Answer

Having the patient speak in specifics rather than globally will help the nurse understand the patient's perspective. This approach will help the nurse establish rapport with the patient. False reassurances will not facilitate communication with the patient.

Question 8

The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after:

Accepted Answer

Individuals who believe in culture-bound illnesses usually also believe that the cure for the illness is found in treatment by a native healer or roots doctor. The parent would not believe that any of the other options are effective.

Question 9

A Hispanic parent says, "An old woman gave my baby the evil eye." The health care provider determines that the infant is physically healthy. The most culturally competent intervention would be to:

Accepted Answer

An individual who believes in mal ojo will also believe that Western medicine is ineffective to treat it. This person will believe that because the illness has an unnatural cause, treatment is best conducted by a native healer who can remove the spell. The parent would not view offering no treatment or casting doubt on evil eye as a superstition as helpful, making these options culturally insensitive. A cool water bath could destabilize an infant's body temperature.

Question 10

A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine:

Accepted Answer

The assessment depends on communication. The nurse should first determine whether or not an interpreter is needed. The other information can be subsequently assessed when communication is effective.

Question 11

A parent said, "My child had mal ojo, so I did not give her the medicine for an ear infection." The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse would analyze that the situation occurred because of:

Accepted Answer

A parent who believes that his or her child's illness is the result of a spell cast on him or her will not understand the need for giving the child medication on a regular basis for several days. Diagnosing noncompliance will not help resolve the problem. Cultural negotiation and repatterning will be necessary. The other options do not present viable explanations.

Question 12

A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools. Group sessions are short and concise. After the group session, the patients are most likely to believe that:

Accepted Answer

Hispanic individuals usually have a relational worldview. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task. An individual with a relational worldview would be unlikely to hold any of the other views.

Question 13

A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence?

Accepted Answer

Brushing up on Middle Eastern culture would be a sensitive action that might result in a lowering of barriers between the nurse and patient. It would not be necessary to serve beverages during the interview. A translator would probably not be needed if the patient is a college professor. Shaking hands with Middle Easterners is acceptable.

Question 14

A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse's most appropriate initial intervention?

Accepted Answer

Recognition of the characteristic marks of coining or skin scraping can keep the nurse from making a culturally insensitive judgment that child abuse is occurring. Coining is used by Asian families to restore equilibrium for babies and small children. The other options would be inappropriate or ineffective.

Question 15

A clinic patient comes to an appointment carrying a baby. The nurse notes abrasions on the baby's thighs and determines that skin scraping has been used. In an effort to use cultural negotiation, the nurse should:

Accepted Answer

Cultural negotiation is the nurse's ability to work within a patient's cultural belief system to develop culturally appropriate interventions. Only by suggesting a modification of the technique of skin scraping so as to perform it in a manner that will not cause injury or the potential for infection can the nurse reflect cultural negotiation.

Question 16

A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient's self-esteem, but after 3 weeks the patient's eye contact was unchanged. Select the accurate analysis of this scenario.

Accepted Answer

The amount of eye contact a person engages in is often culturally determined. In some cultures eye contact is considered insolent, whereas in others eye contact is expected and valued. Korean-Americans often prefer not to engage in direct eye contact.

Question 17

A nurse begins work at an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after:

Accepted Answer

Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer.

Question 18

A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge?

Accepted Answer

The European-American perspective of acquiring knowledge evolves through acquiring proof that something exists using the personal senses. The distracters describe the beliefs of other cultural groups.

Question 19

A patient of Cuban descent is hospitalized with depression. Which factor is most applicable to care planning?

Accepted Answer

Patients of Hispanic cultures often have relational worldviews. Individuals who have a relational worldview usually desire the involvement of family, religious advisors, and even friends during health care visits and the planning of interventions. The patient's consent is required for this involvement. The other options reflect alternative worldviews.

Question 20

A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore:

Accepted Answer

Patients who view illness as disequilibrium or lack of balance may seek alternative therapies to restore balance. Chi is an energy force. Meridians are lines in the body representing body functions. Divine relationships are an aspect of balance, but equilibrium is a broader concept.

Quiz 5: Cultural Issues