Book Practice Questions Flashcards
A nurse midwife is assisting a patient whose birth plan states she is firmly committed to natural childbirth. When informed the infant is in distress and a cesarean delivery is necessary, the pregnant patient sobs inconsolably, calling herself a failure. The nurse offers emotional support based on what likely types of losses? Select all that apply.
a. Actual
b. Perceived
c. Psychological
d. Anticipatory
e. Physical
f. Maturational
a, b, c. The losses experienced by the pregnant patient are actual, perceived, and psychological. Actual loss can be recognized by others, such as the loss of a child. Perceived loss is felt by the person but is intangible to others, such as the loss of self-esteem. Psychological loss is felt by the person. Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Physical loss involves the loss of life, a body part, or a function. Maturational loss is experienced as a result of natural developmental processes
A hospice nurse who cared for a dying patient and their family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? Select all that apply.
a. The family arranges for a funeral for their loved one.
b. The family arranges for a memorial scholarship for their loved one.
c. The coroner pronounces the patient’s death.
d. The family arranges for hospice for their loved one.
e. The patient is diagnosed with terminal cancer.
f. The patient’s daughter writes a poem expressing her sorrow.
a, b, f. Mourning includes the actions by which a person shows grief. Behaviors associated with mourning often are culturally influenced and may include ceremonies such as a funeral or memorial service. Writing a poem expressing sorrow is also a manifestation of grief. The coroner pronouncing death is a legal event. Arranging hospice care occurs before death. The diagnosis of terminal cancer may lead to anticipatory grief
An older adult who recently moved into a long-term care facility tells the nurse their only son died 20 years ago, and they haven’t enjoyed life since. When giving report to the next shift, the nurse tells the oncoming nurse the resident seems to be suffering from which type of grief?
a. Somatic
b. Anticipatory
c. Unresolved
d. Inhibited
c. Unresolved grief exists when a person is unable to express feelings of loss or when the person has socially unacceptable feelings. The person may have a prolonged reaction or may not acknowledge the impact of the loss on their life. Somatic grief is characterized by bodily symptoms. Anticipatory grief is the unconscious process of disengaging or “letting go” of someone before the actual loss occurs. Inhibited grief occurs when a person suppresses feelings of grief
A home health care nurse has been caring for a patient with advanced AIDS who is working through the stages of death and dying. The nurse documents the patient has entered the acceptance phase of death when the patient makes which statement?a. “I’ve made peace with everyone, and I’m actually ready to move on.”
b. “God cannot possibly be good if He allows people to get this horrible disease.”
c. “I just want to get better. A friend of mine had success with a plant-based diet.”
d. “The test results must be mixed up with someone else’s; I feel better now.”
a. According to Kübler-Ross, when the patient reaches the stage of acceptance, they feel tranquil. This patient has accepted the reality of death and is prepared for the transition to death. In the stage of anger, the patient expresses rage and hostility and adopts a “why me?” attitude. In the bargaining stage, the patient tries to barter for more time. In the depression phase, the patient goes through a period of grief before death. Denial is characterized by the patient’ s refusal to believe that the loss is happening
A patient tells the nurse it is unfair that they should have to die now when they have finally made peace with their family. Which response by the nurse would be most appropriate?
a. “I’m sorry you’re feeling this way when death is inevitable.”
b. “It does seem unfair. Tell me more about how you are feeling.”
c. “You’ll come to acceptance soon; no one knows how much time they have.”
d. “Tell me about your pain. Did it keep you awake last night?”
b. This response by the nurse validates the patient’ s feelings, saying they have been heard, and invites them to share more of their feelings, concerns, and fears. The other responses either deny the patient’ s feelings or change the subject
A nurse is caring for a terminally ill patient who says, “I just can’t sleep. I keep worrying about what my family will do when I am gone.” What response by the nurse is most appropriate?
a. “You need your sleep for your visitors tomorrow.”
b. “What seems to be concerning you the most?”
c. “Your family told me they will be fine.”
d. “I suggest you discuss this with your family.”
b. Using an open-ended question, such as, “What seems to be concerning you the most? ” encourages communication. False reassurances or side-stepping the statement are not helpful. The nurse then would assess the patient’ s restlessness and consider possible comfort measures
A patient tells a nurse that their daughter has been appointed to make decisions for them should they become incapacitated. What follow-up question would the nurse ask?
a. “Did the health care provider complete a Physician Order for Life-Sustaining Treatment (POLST) form?”
b. “Do we have a copy of your durable power of attorney for health care?”
c. “Have you prepared a living will?”
d. “Should I phone your provider for you to sign an Allow Natural Death (AND) form?”
b. A durable power of attorney for health care appoints an agent the person trusts to make decisions in the event of subsequent incapacity. Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. A POLST form is a medical order indicating a patient’ s wishes regarding treatments commonly used in a medical crisis. The living will is a document whose purpose is to allow people to record specific instructions about the type of health care they would like to receive in particular end-of-life situations. AND on the medical record of a patient indicates the patient or surrogate has expressed a wish that there be no attempts to resuscitate the patient
A group of nursing students in a leadership course are studying the ANA position regarding assisted suicide. The professor asks the students for the best response to a note written by a ventilator-dependent patient “help me end my suffering, I don’t want to live anymore.” Which nursing response is consistent with the ANA’s position?
a. “I will do everything possible to keep you comfortable but will not administer medication to cause your death.”
b. “Being removed from the ventilator is a form of active euthanasia, which is not supported by the nurses’ code of ethics.”
c. After exhausting every intervention to keep a dying patient comfortable, the nurse says, “Let’s talk about when and how you want to die.”
d. “I’m personally opposed to assisted suicide, but I’ll find you a colleague who can help you.”
a. The ANA Code of Ethics states that the nurse “should provide interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life” (2015, p. 3). Removing mechanical ventilation or other life support at the patient’ s request or request of the surrogate when treatment is futile is not performed with the sole intent to end life but to promote dignity and comfort. Nurses should be prepared to respond to the request: “Nurse, please help me die….”
A patient with end-stage breast cancer has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse that his wife was very clear about not wanting aggressive treatment that would merely prolong her dying. Which type of order could the nurse suggest the husband discuss with his wife’s health care provider?
a. Comfort Measures Only
b. Do Not Hospitalize
c. Living Will
d. Slow Code Only
a. The nurse could suggest that the husband speak to the health care provider about a Comfort Measures Only order in which the goal of treatment is a comfortable, dignified death, and further life-sustaining measures have been declined. A Do-Not-Hospitalize order is often used for patients in long-term care and other residential settings who refuse hospitalization for further aggressive treatment. A living will is a document in which the patient provides specific instructions about the kinds of health care that should be provided or foregone in particular situations in which they are unlikely to recover. A Slow Code refers to a delay in calling a code and beginning resuscitation efforts until these measures will be ineffective. This is not consistent with current best practice and may be forbidden in certain facilities. A nurse could be charged with negligence in the event of a Slow Code and resulting patient death
A nurse in the intensive care unit is preparing a patient’ s family for terminal weaning from mechanical ventilation. What nursing actions would facilitate this process? Select all that apply.
a. Offering the family information about the advantages and disadvantages of continued ventilatory support
b. Explaining to the family what will happen at each phase of the weaning and offer support
c. Validating orders for sedation and analgesia to promote comfort and dignity
d. Explaining that death occurs quickly after the patient is removed from the ventilator
e. Teaching the family that the decision for terminal weaning must be made by the primary care provider
f. Arranging mandatory counseling for the patient and family to assist them in making this end-of-life decision
a, b, c. A nurse’ s role in terminal weaning is to assist patients and families in the decision-making process by offering helpful information about the benefits and burdens of continued ventilation. The nurse teaches what to expect if terminal weaning is initiated, including the use of sedation and analgesia for patient comfort. Supporting the patient and family and managing sedation and analgesia are critical nursing responsibilities. In some cases, competent patients decide that they want to discontinue their ventilatory support; more often, the surrogate decision makers determine that continued ventilatory support is futile. The nurse would not predict the time until death. Once removed from the ventilator, a patient may not resume spontaneous breathing or may breathe on their own, living for hours, days, or rarely, longer. Counseling may be arranged if requested but is not mandatory for decision making
A nurse is caring for a patient who just died. The family asks to be left alone with the body. Which action by the nurse is most appropriate?
a. Discourage the family from staying with the body for more than 15 minutes.
b. Explain that hospital policy requires the body to be moved to the morgue immediately.
c. Dim the lights and provide soft blankets and chairs for the family.
d. Tell the family you will be back in 1 hour to take the body to the morgue.
c. Providing a comfortable and private environment for the family to be with the deceased demonstrates respect and supports their grieving process
A nurse is caring for terminally ill patients in a long-term care setting. Which nursing action is appropriate during end-of-life care?
a. Avoiding disturbing a comatose patient by speaking to them while providing care
b. Holding the hand of a dying patient and crying with the patient and family
c. Requesting a social work consult for family members with multiple complaints about the care
d. Performing hygiene for the patient because it is easier than having the patient help
b. The nurse should not be afraid to show compassion and empathy for the dying person, including crying with the patient or family. The sense of hearing is believed to be the last sense to leave the body before death; therefore, the nurse should explain care to comatose or unresponsive patients. The nurse should address caregiver role endurance by actively listening to family members. Encouraging the dying patient to remain active and participate in care for as long as possible is appropriate, rather than taking over self-care measures
After validating an autopsy is not planned, a new graduate nurse provides postmortem care. Which action requires the preceptor to correct the graduate?
a. Leaving the patient in a sitting position at the family’ s request
b. Placing identification tags on both the shroud and the ankle
c. Removing soiled dressings and tubes, while washing the body
d. Ensuring a death certificate is issued and signed
c. After validating that an autopsy is not planned, the nurse prepares the body for the family and transfer to the morgue or funeral home. Unless there are specific religious or cultural practices, washing the body is usually the responsibility of the mortician. Soiled dressings should be replaced, and tubes are typically removed unless an autopsy is planned. The body should be placed in a normal anatomic position, and identification tags are placed according to facility policy. Ensuring the death certificate is issued is usually an administrative task
The family of a patient who has just died asks for privacy and supplies to wash their loved one’s body. How does the nurse best respond?
a. Inform the family that there is no need for them to wash the body since the funeral home typically does this.
b. Explain that hospital policy forbids their being alone with the deceased patient.
c. Provide the requested the supplies and maintain a watchful eye to ensure they maintain the patient’ s dignity.
d. Provide the requested supplies, assess if this request is linked to religious or cultural customs, and offer assistance.
d. Providing the requested supplies and assessing if this request is linked to religious or cultural customs demonstrates respect for the family’s wishes. In cultures in which the family’ s washing of the deceased’s body is considered the last service a family can give a loved one, they should be given the necessary supplies and left alone in the room with the body
An older adult who has had multiple strokes is refusing artificial nutrition and hydration against medical advice and in opposition to their daughter. The patient’ s nurse advocates for the patient, stating which party is the most appropriate decision maker? Electronic Health Record (EHR), Consultations Tab Psychiatric Consult: Patient is competent, understands the consequences of her actions, no depression noted. Patient persists in refusing treatment. Suggest ethics consultation.
a. Patient
b. Patient’ s daughter
c. Health care provider
d. Ethics consult team
a. The psychiatric consult indicates the patient is competent and understands the consequences of their decision. A competent adult patient has the right to refuse medical treatment, including artificial nutrition and hydration, even if it may lead to death. The patient’ s daughter or other family members do not have the legal authority to override a competent patient’ s decision. While the health care provider can offer recommendations, the decision ultimately belongs to the competent patient. The ethics consult team can provide guidance and help resolve conflicts but does not have the authority to make decisions for a competent patient
A nurse receives information in a shift report that a patient who has rapidly progressing terminal illness is in the denial phase of death and dying. The nurse expects a patient in this stage to make which statement?
a. “I can’t wait to get out of the hospital and plan next year’ s beach vacation.”
b. “I’ve chosen my favorite music and readings for my memorial service.”
c. “The people in this hospital are so incompetent, what a bunch of idiots! ”
d. “I cry every time I wonder how my children will get along when I’m gone.”
a. In the denial phase, the patient denies the reality of death and may repress what is discussed. The patient may think, “They made a mistake in the diagnosis” or “they mixed up my records with someone else’ s.” Planning a vacation for the following year indicates the patient is not ready to take in the information. When the stage of acceptance is reached, the patient feels tranquil and has accepted the reality of and is prepared for death. The patient may think, “I’ve tied up all the loose ends”. In the anger phase, the patient expresses rage and hostility and may adopt a “why me?” attitude. During the depression phase, the patient goes through a period of grief before death. The grief is often characterized by crying and not speaking much
A nurse notes a hospice patient is increasingly agitated, with noisy, irregular breathing and periods of apnea. The skin of their feet appears mottled. The nurse takes which action?
a. Activates the rapid response team to treat shock
b. Contacts the respiratory therapist for a nebulizer treatment
c. Prepares the patient’ s family for imminent death
d. Inserts an oropharyngeal airway for suctioning
c. Signs of imminent death include difficulty talking or swallowing; urinary or bowel incontinence or constipation; loss of movement, sensation, and reflexes; decreasing body temperature with cold or clammy skin; weak, slow, or irregular pulse and decreasing blood pressure; noisy, irregular, or Cheyne–Stokes respirations; restlessness or agitation and/or; cooling, mottling, and cyanosis of the extremities and dependent areas. The purpose of hospice care is to provide comfort as death approaches rather than invasive interventions. As death approaches, the irregular noisy breathing is expected; nebulizer treatments are not the priority
A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse, “I feel no connection to God” and “I’m worried that I’ve found no real meaning in life.” What is the nurse’ s best response to this patient?
a. Give the patient a hug and tell them that their life still has meaning.
b. Arrange for a spiritual advisor to visit the patient.
c. Ask if the patient would like to talk about their feelings.
d. Call in a close friend or relative to talk to the patient.
c. When caring for a patient who is in spiritual distress, the nurse should listen to the patient first, then ask whether the patient would like to visit with a spiritual advisor. Arranging for a spiritual advisor first may not be respectful of the patient’ s wishes. A hug and false reassurances do not address the problem of spiritual distress. Talking to friends or relatives may be helpful, but only if the patient agrees.
A nurse who was raised as a strict Roman Catholic but is no longer practicing stated they could not assist patients with spiritual distress because they recognize only a “field of power” in each person. The nurse says to her colleague, “My parents and I hardly talk because I’ve deserted my faith. Sometimes I feel really isolated from them and God—if there is a God.” These statements reveal which unmet spiritual need?
a. Meaning and purpose
b. Forgiveness
c. Love and relatedness
d. Strength for everyday living
c. The data point to an unmet spiritual need to experience love and belonging, given the nurse’ s estrangement from their family and God after leaving the church. The other options may represent other needs this nurse has, but the nurse’ s statements do not support them.
A nurse in a long-term care facility is performing spirituality assessments of residents on their unit. What is the best question the nurse could use to assess for spiritual needs?
a. “Can you describe your usual spiritual practices and how you maintain them daily?”
b. “Are your spiritual beliefs causing you any concern?”
c. “How can I and the other nurses help you maintain your spiritual practices?”
d. “How do your religious beliefs help you to feel at peace?”
c. Questioning how the staff can meet patients’ spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices is an assessment of spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.
A patient who stated their religion as Jewish at the intake interview was served a kosher meal ordered from a restaurant on a paper plate because the hospital had no provision for kosher food or dishes. The patient became angry and accused the nurse of insulting him, emphatically stating, “I want to eat what everyone else does—and give me decent dishes.” After analyzing the data, the nurse returns to the patient and makes which of these statements?
a. “I’m terribly sorry, I should have ordered kosher food and dishes as well.”
b. “Did someone on the staff behave condescendingly or critically?”
c. “It seems difficult to please you today.”
d. “We did not ask about your dietary preferences; tell me what you usually eat.”
d. On the basis of the patient’ s stated religion, the nurse assumed they would want a kosher diet. This is a form of stereotyping. When evaluating the outcome of the situation, the nurse returns to the first step of the nursing process and assesses the patient’ s dietary practices and preferences.
A surgeon tells a patient who is a Jehovah’s Witness that they need emergency surgery to repair an aortic aneurysm, which will require blood transfusions. The patient states, “If I receive blood, I will not go to paradise. It is against my religion.” What nursing response to the patient is appropriate?
a. “I understand you will not receive blood products, even if it means you will die.”
b. “Please listen to the surgeon; I’ve seen many aneurysms successfully repaired”
c. “Have you discussed your decision to refuse surgery with your family?”
d. “What can I say to help you through this difficult decision?”
a. Patients who practice the Jehovah’s Witness faith believe blood transfusions violate God’s laws and do not allow them. The nurse supports the patient’ s beliefs. It is disrespectful of the nurse to attempt to coerce a decision or impose their beliefs on the patient.
The Roman Catholic family of an infant born with hydrocephalus requests a baptism for their infant. The nurse advocates for the family’ s wishes to be honored for which reason?
a. Baptism frequently helps postpone or prevent death or suffering.
b. It is legally required that the nurse provide for this care when requested.
c. It is a nursing function to assure the salvation of the infant.
d. Not facilitating the baptism may increase the family’ s sorrow and suffering.
d. Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family’ s sorrow and suffering. Whether baptism postpones or prevents death and suffering is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, and although some nurses may believe part of their role is to ensure the salvation of the infant, this function could be rejected by many.
A nurse is caring for patients in a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of these patients? Select all that apply.
a. Asking a Buddhist if they have any diet restrictions related to the observance of holy days
b. Asking a Christian Scientist who is in traction if they would like to try nonpharmacologic pain measures
c. Administering medications to a Hindu patient and avoiding touching the patient’ s lips
d. Asking a Roman Catholic patient if they would like to attend Mass in the common room on Sunday
e. Avoiding scheduling treatment and procedures on Saturday for a Jewish patient
f. Consulting with the medicine man of a Native American patient and incorporating their suggestions into the care plan
a, b, d, f. The nurse should ask a Buddhist if they have any diet restrictions related to the observance of holy days. Since Christian Scientists avoid the use of pain medications, the nurse should offer nonpharmacologic pain relief measures. A nurse administering medications to a Hindu patient avoids touching the patient’ s lips. A nurse should ask a Roman Catholic if they would like to attend Mass on Sunday. The nurse is careful not to schedule treatment and procedures on Saturday for a Jewish patient who observes the Sabbath. The nurse would appropriately consult with the medicine man of a Native American patient and incorporate their suggestions into the care plan.
A nurse who is caring for patients on a pediatric unit is assessing children’s spiritual needs. Which is the most important source of learning for a child’ s own spirituality?
a. Child’s church or religious organization
b. What their parents say about God and religion
c. Their parents’ behavior in relationship to the family, others, and to God
d. Family’ s spiritual advisor
c. Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God (or a higher being). What parents say about God and religion, the family’ s spiritual advisor, and the child’ s church or religious organization are less important sources of learning.
A nursing student is caring for a patient admitted with chest pain related to aortic valve stenosis. The student notes the patient, who had been calm and cooperative the day before, has become contemplative and withdrawn, stating, “I’ve never thought much about dying, but my chances of making it through tomorrow’s surgery are 50-50.” How does the student best respond when the clinical professor asks the student why this behavior likely surfaced later in the patient’ s admission?
a. Patients usually want to maintain privacy about their spiritual needs.
b. People are better able to focus on spiritual needs after their spiritual advisor visits.
c. Family members and close friends often initiate spiritual concerns.
d. Illness increases spiritual concerns, which may initially be difficult to verbalize.
d. Illness may increase spiritual concerns, which many patients find difficult to initially express. The other options presume patients are purposefully secretive or must speak with a spiritual advisor, friends, or family to promote discussion of spiritual concerns. Spirituality is anything that pertains to a person’s relationship with a nonmaterial life force or higher power; there is no universal definition, as the experience is individual and personal
A nurse who is comfortable with spirituality is caring for a patient who needs spiritual counseling. What action will the nurse take first?
a. Calling the patient’ s own spiritual advisor
b. Asking if the patient has a spiritual advisor they wish to consult
c. Counseling the patient and, if unsuccessful, making a referral to a spiritual advisor
d. Explaining the best health options for the patient to the spiritual advisor
b. Even when a nurse feels comfortable discussing spiritual concerns, they should always determine whether the patient has a spiritual advisor they would like to consult. Calling the patient’ s spiritual advisor may be premature if it is a matter the nurse can handle. The other two options deny the patient’ s right to speak privately with their spiritual advisor from the outset, if that is their preference
A patient states they feel very isolated from their family and church, and even from God, “in this huge medical center so far from home.” When preparing expected outcomes for this patient, which most appropriately measures relief of the patient’ s spiritual distress?
a. The patient will express satisfaction with the compatibility of their spiritual beliefs and everyday living.
b. The patient will identify spiritual beliefs that meet their need for meaning and purpose.
c. The patient will express peaceful acceptance of limitations and failings.
d. The patient will identify spiritual supports available to them in this medical center.
d. Each of the four options represents appropriate spiritual goals, but identifying spiritual supports available to this patient in this medical center at this point in time, is the most appropriate and realistic
A patient who lost their home, spouse, and children in a fire is depressed and states that they have no reason to live. The patient states, “My family was my life.” The nurse documents a health problem of Spiritual Distress based on the patient’ s inability to find meaning and purpose in their current situation. What is the priority nursing action for this patient?
a. Asking the patient which spiritual advisor they would like you to call
b. Recommending that the patient engage in spiritual or religious readings
c. Determining what has given the patient meaning and purpose in the past
d. Reminding the patient that God is a loving and personal God
c. The nurse prioritizes determining what, in addition to their family, has given the patient’ s life meaning and purpose in the past. This helps the patient focus on their strengths. This assessment data can be used to further plan individualized spiritual care.
After terminating a pregnancy, a patient tells the nurse, “I shouldn’t have had that abortion because I’m Catholic, but what else could I do? I’m afraid I’ ll never get close to my mother or back in the Church again.” They then talk with their priest about this feeling of guilt. Which evaluation statement shows a solution to the problem?
a. Patient stated, “I wish I had talked with the priest sooner. I now know God has forgiven me, and my mother is beginning to understand.”
b. Patient has slept from 10 PM to 6 AM for 3 consecutive nights without medication.
c. Patient has developed mutually caring relationships with others.
d. Patient has identified several spiritual beliefs that give purpose to their life.
a. The patient’ s statements indicate feelings of guilt, which has caused spiritual distress. Only option a clearly evaluates whether the patient’ s feelings of guilt have resolved after speaking to the priest.
A parish nurse is speaking to a congregant whose adolescent child was arrested for shoplifting. The congregant is very angry, stating they cannot face the child, let alone discuss the situation: “I just will not tolerate a thief.” What nursing action will best assist the congregant at this time?
a. Assuring the congregant that many parents feel the same way
b. Reassuring the congregant that many teenagers act rebelliously and that it will pass
c. Assisting the congregant to identify how withholding forgiveness hurts them
d. Asking the congregant if they have spent sufficient time with their child
c. Helping the congregant identify how their unforgiving feelings may be harmful to themselves is the only intervention that directly addresses forgiveness, a universal spiritual need. Assuring the congregant that many parents would feel the same way or that many teenagers shoplift out of rebelliousness may make them feel better initially, but this does not address the benefits of forgiveness. Suggesting the congregant may not have spent enough time with their child may be untrue and could promote guilty feelings, when they may be unwarranted.
A hospice nurse who provides pastoral care is teaching nursing students about the three spiritual needs believed to be common to all people. Which of these will the nurse include in the discussion? Select all that apply.
a. Food, clothing, and shelter
b. Meaning and purpose
c. Family
d. Love and relatedness
e. Forgiveness
f. Rules to live by
b, d, e. Meaning and purpose, love and relatedness, and forgiveness are the three spiritual needs believed to be common to all people. Option a is a human need as described by Maslow, as is family (love and belonging). Many people live by a set of rules, but this is not a common spiritual need.
A nurse is caring for patients of diverse cultures in a community health clinic. Which concepts will the nurse incorporate to guide the plan of care? Select all that apply.
a. The United States has become less inclusive of same-sex couples.
b. Cultural diversity is limited to people of varying cultures and races.
c. Cultural diversity is separate and distinct from health and illness.
d. People may be members of multiple cultural groups at one time.
e. Culture guides what is acceptable behavior for people in a specific group.
f. Cultural practices may evolve over time but mainly remain constant.
d, e, f. A person may belong to multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, mainly remaining constant as long as they satisfy a group’s needs. The United States has become more inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biologic sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, an integral component of health and illness, includes culture, ethnicity, and race
At the last staff meeting, the nurse manager discussed the organizational initiative to improve provision of culturally competent care. During rounds, which behaviors inconsistent with this goal require the manager to intervene? Select all that apply.
a. A staff nurse tells the AP that patients should not be given a choice, but should shower or bathe daily.
b. A nurse asks the family of a patient who has died if they would like to wash their loved one’s body.
c. A nurse tells another nurse that Jewish dietary restrictions are just a way for them to get special foods.
d. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence.
e. A nurse obtains a translator to speak to the patient in their native language.
f. A nurse refuses to care for a married gay patient who is HIV positive because the nurse is against same-sex marriage.
a, d. Cultural imposition occurs when someone believes others should conform to their beliefs, such as whether or not to shower or bathe daily, when a Catholic nurse insists that a terminally ill patient see a chaplain. Cultural blindness occurs when a nurse treats all patients the same regardless of culture. Culture conflict occurs when a nurse judges a patient’ s dietary restrictions as a way to get their favorite foods. When a nurse refuses to respect an older adult’ s ability to speak for themselves, or refuses to treat a patient based on their sexual orientation, stereotyping has occurred
An ambulatory care nurse serving a large, culturally diverse population is planning a free blood pressure screening clinic. Based on the nurse’ s understanding of racial differences in health and illness, which groups will the nurse target for screening? Select all that apply.
a. Native American people
b. African American people
c. Alaska Native people
d. Asian people
e. White people
f. Hispanic people
b, c, e. African American people, Asian people, and White people are more prone to developing hypertension. Alaska Native individuals and Native American individuals are prone to heart disease, diabetes, cirrhosis, and fetal alcohol syndrome
A nurse tells a patient, “tonight’ s menu selection is pork. I understand many people in your culture do not eat pork; may I order something else for you? ” When the patient states they no longer observe this dietary practice, the nurse understands that the patient has experienced what transition?
a. Cultural assimilation
b. Cultural imposition
c. Culture shock
d. Ethnocentrism
a. Assimilation occurs when minority groups living within a dominant group lose the cultural characteristics that make them different. In this scenario, the patient, who might have previously adhered to a cultural practice of not eating pork, no longer observes this practice, indicating a loss of a cultural characteristic. Cultural imposition occurs when one person believes that everyone should conform to their own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange. Ethnocentrism is the belief that the ideas, beliefs, and practices of one’s own cultural group are best, superior, or most preferred to those of other groups
A nurse is using the Explanatory Model of Health and Illness (ESFT) model to assess how a patient from another culture views their diagnosis of chronic obstructive pulmonary disease (COPD). What interview question is most appropriate to assess the E aspect of this model?
a. How do you get your medications?
b. How does having COPD affect your lifestyle?
c. Are you concerned about the side effects of your medications?
d. Can you describe how you will take your medications?
b. The ESFT model, a cross-cultural communication tool, guides providers in understanding a patient’ s explanatory model (a patient’ s conception of their illness), social and environmental factors, and fears and concerns and also guides providers in contracting for therapeutic approaches. Asking the questions: “How does having COPD affect your lifestyle? ” explores the explanatory model, “How do you get your medications? ” refers to the social and environmental factor, “Are you concerned about the side effects of your medications? ” addresses fears and concerns, and “Can you describe how you will take your medications? ” involves therapeutic contracting
The charge nurse overhears a nurse state, “That patient is 78 years old—too old to learn how to change a dressing.” How should the charge nurse respond?
a. “Please don’t impose your view of the patient’ s culture on them.”
b. “I wish you would try to demonstrate more cultural sensitivity.”
c. “Try to be open to your patient’ s culture, to make the biggest impact.”
d. “Grouping all older adults as having trouble learning is a form of stereotyping.”
d. Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. The information in this scenario does not suggest the nurse is not open to her patient’ s culture.
A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish, and the nurse speaks only English. Which action should the nurse take next?
a. Use short words and speak loudly
b. Obtain a medical interpreter
c. Explain why care cannot be provided
d. Provide instructions in writing
b. Requesting an interpreter reflects best practice. Qualified interpreters, available in many facilities or via video or phone, have knowledge of health care and can provide assistance. Using short words, talking loudly, and providing instructions in writing will not aid communication. Explaining why care cannot be provided will not meet the patient’ s health needs; the nurse is required to provide care. Since the patient doesn’t speak English, this will not be understood
A nurse is interviewing a newly admitted patient from another culture. What question best displays cultural sensitivity?
a. “Do you think you’ ll be able to eat the food we have here? ”
b. “Y ou do understand that we can’t prepare special meals? ”
c. “What types of food do you typically prepare for meals? ”
d. “Could you make an exception on what food you eat while you are here? ”
c. Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive
A nurse tells a new mother from Africa that she should not carry her infant in a sling because bassinets are safer. The charge nurse suggests the nurse is displaying which behavior?
a. Cultural imposition
b. Clustering
c. Cultural competency
d. Stereotyping
a. The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years
A community organization includes provision of culturally competent care in their mission. Which action has the organization set as a priority?
a. Learning the predominant language of the community
b. Obtaining significant information about the community
c. Treating each patient at the clinic as an individual
d. Recognizing the importance of the patient’ s family
c. In all aspects of nursing, patients should be treated as individuals; this remains true when providing culturally competent care. Additional ways to provide culturally competent care include learning the predominant language in the community, researching the patient’ s culture, and recognizing the influence of family on the patient’ s life
A surgeon will not attempt a life-saving repair of a ruptured aneurysm unless the patient agrees to receive blood transfusions. Although receiving blood products is against the patient’ s religious beliefs, the surgeon ordered four units of packed red blood cells. What action will the nurse take first?
a. Administer the blood transfusion
b. Call the patient’ s family and ask them to reason with the patient
c. Discuss obtaining a court order to save the patient’ s life
d. Maintain the patient’ s comfort and support their decision
d. The nurse does not force patients to participate in care that conflicts with their values. Imposing such care may engender feelings of guilt and alienation from a religious or cultural group and create a threat to the patient’ s well-being
