Chapter 5 - Cultural Implications

Question 1

Which Western cultural feature may result in establishing unrealistic outcomes for clients of other cultural groups?

a. Interdependence
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems

Answer 1

d. Direct confrontation to solve problems

Question 2

A psychiatric nurse leads a medication education group for Hispanic clients. This nurse holds a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After the group, the clients are most likely to believe

a. the nurse was uncaring.
b. the session was effective.
c. the teaching was efficient.
d. they were treated respectfully.

Answer 2

a. the nurse was uncaring.

Question 3

To provide culturally competent care, the nurse should focus on what action?

a. accurately interpreting the thinking of individual clients.
b. predicting how a client may perceive treatment interventions.
c. formulating interventions to reduce the client’s ethnocentrism.
d. identifying strategies that fit within the cultural context of the client.

Answer 3

d. identifying strategies that fit within the cultural context of the client.

Question 4

A black client, originally from Haiti, has a diagnosis of major depressive disorder. A colleague tells the nurse, “This client often looks down and is reluctant to share feelings. However, I’ve observed the client spontaneously interacting with other clients of color.” Select the nurse’s best response.

a. “Clients of color depend on the church for support. Have you consulted the client’s pastor?”
b. “Encourage the client to talk in a group setting. It will be less intimidating than one-to-one interaction.”
c. “Don’t take it personally. Clients of color often have a resentful attitude that takes a long time to overcome.”
d. “The client may have difficulty communicating in English. Have you considered using a cultural broker?”

Answer 4

d. “The client may have difficulty communicating in English. Have you considered using a cultural broker?”

Question 5

A Haitian client diagnosed with major depressive disorder tells the nurse, “There’s nothing you can do. This is a punishment. The only thing I can do is see a healer.” The culturally aware nurse assesses that the client is demonstrating what?

a. Delusions of persecution.
b. A misdiagnosed of depression.
c. The believe that distress is the result of a curse or spell.
d. Feelings of hopeless and helpless related to an unidentified cause.

Answer 5

c. The believe that distress is the result of a curse or spell.

Question 6

A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A client, who was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best explains this behavior?

a. The client wants to lead the group and give directions to others.
b. The client wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The client does not want to be late.
d. The behavior indicates feelings of self-importance that the client wants others to appreciate.

Answer 6

c. The military culture values timeliness. The client does not want to be late.

Question 7

A nurse in the clinic has a full appointment schedule. A Hispanic American client arrives at 1230 for a 1000 appointment. A Native American client does not keep an appointment at all. What understanding about the clients will improve the nurse’s planning?

a. They are members of cultural groups that have a different view of time.
b. They are immature and irresponsible in health care matters.
c. They are acting-out feelings of anger toward the system.
d. They are displaying passive-aggressive tendencies.

Answer 7

a. They are members of cultural groups that have a different view of time.

Question 8

The sibling of an Asian American client tells the nurse, “My sister needs help for pain. She cries from the hurt.” Which
understanding regarding persons of an Asian American heritage will help the nurse contribute to culturally competent care for this client?

a. They often express emotional distress with physical symptoms.
b. They will probably respond best to a therapist who is impersonal.
c. They will require prolonged treatment to stabilize these symptoms.
d. They should be given direct information about the diagnosis and prognosis.

Answer 8

a. They often express emotional distress with physical symptoms.

Question 9

Which communication strategy would be most effective for a nurse to use during an assessment interview with an adult Native American client?

a. Open and friendly; ask direct questions; touch the client’s arm or hand occasionally for reassurance.
b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional face to express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.

Answer 9

c. Soft voice; break eye contact occasionally; general leads and reflective techniques.

Question 10

A Native American client sadly describes a difficult childhood. The client abused alcohol as a teenager but stopped 10 years ago. The client now says, “I feel stupid and good for nothing. I don’t help my people.” How should the treatment team focus planning for this client?

a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytical approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.

Answer 10

d. Use a holistic approach, including mind, body, and spirit.

Question 11

A Native American client describes a difficult childhood and dropping out of high school. The client abused alcohol as a teenager to escape feelings of isolation but stopped 10 years ago. The client now says, “I feel stupid. I’ve never had a good job. I don’t help my people.” Which nursing diagnosis applies?

a. Risk for other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation

Answer 11

b. Chronic low self-esteem

Question 12

Which viewpoint of an Asian American family will most affect decision making about care?

a. The father is the authority figure.
b. The mother is head of the household.
c. Women should make their own decisions.
d. Emotional communication styles are desirable.

Answer 12

a. The father is the authority figure.

Question 13

Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American client diagnosed with a mental illness?

a. Encouraging the family to attend community support groups
b. Involving the client’s family to assist with activities of daily living
c. Providing educational pamphlets to explain the client’s mental illness
d. Restricting homemade herbal remedies, the family brings to the hospital

Answer 13

b. Involving the client’s family to assist with activities of daily living

Question 14

A nurse speaks with family members of a Chinese American parent recently diagnosed with major depressive disorder. Which comment by the nurse will the family find most comforting?

a. “The nursing staff will take good care of your parent.”
b. “The nursing staff will pray with your parent several times a day.”
c. “The nursing staff will teach your parent important self-care strategies.”
d. “The nursing staff will educate your parent about safety information regarding
medication.”

Answer 14

a. “The nursing staff will take good care of your parent.”

Question 15

A client in the emergency department shows a variety of psychiatric symptoms, including restlessness and anxiety. The client says, “I feel sad because evil spirits have overtaken my mind.” Which worldview is most applicable to this individual?

a. Eastern/balance
b. Southern/holistic
c. Western/scientific
d. Indigenous/harmony

Answer 15

d. Indigenous/harmony

Question 16

A nurse prepares to teach important medication information to a client of Mexican heritage. How should the nurse manage the teaching environment?

a. Stand very close to the client while teaching.
b. Maintain direct eye contact with the client while teaching.
c. Maintain a neutral emotional tone during the teaching session.
d. Sit 4 feet or more from the client during the teaching session.

Answer 16

a. Stand very close to the client while teaching.

Question 17

A Chinese American client diagnosed with an anxiety disorder says, “My problems began when my energy became imbalanced.” The nurse asks for the client’s ideas about how to treat the imbalance. Which comment would the nurse expect from this client?

a. “My family will bring special foods to help me get well.”
b. “I hope my health care provider will prescribe some medication to help me.”
c. “I think I would benefit from talking to other clients with a similar problem.”
d. “I would like to have a native healer perform a ceremony to balance my energy.”

Answer 17

a. “My family will bring special foods to help me get well.”

Question 18

An experienced psychiatric nurse plans to begin a new job in a community-based medication clinic. The clinic sees culturally diverse clients. Which action should the nurse take first to prepare for this position?

a. Investigate cultural differences in clients’ responses to psychotropic medications.
b. Contact the clinical nurse specialist for guidelines regarding cultural competence.
c. Examine the literature on various health beliefs of members of diverse cultures.
d. Complete an online continuing education offering about psychopharmacology.

Answer 18

a. Investigate cultural differences in clients’ responses to psychotropic medications.

Question 19

A psychoeducational session will discuss medication management for a culturally diverse group of clients. Group participants are predominantly members of minority cultures. Of the four staff nurses below, which nurse should lead this group?

a. Very young registered nurse
b. Older, mature registered nurse
c. Newly licensed registered nurse
d. A registered nurse who is very thin

Answer 19

b. Older, mature registered nurse

Question 20

A nurse wants to engage an interpreter for a severely anxious 21-year-old male who immigrated to the United States 2 years ago. Of the four interpreters below who are available and fluent in the client’s language, which one should the nurse call?

a. 65-year-old female professional interpreter
b. 24-year-old male professional interpreter
c. A member of the client’s family
d. The client’s best friend

Answer 20

b. 24-year-old male professional interpreter

Question 21

A client who has been hospitalized for 3 days with a serious mental illness says, “I’ve got to get out of here and back to my job. I get 60 to 80 messages a day, and I’m getting behind on my email correspondence.” What is this client’s perspective about health and illness?

a. Fateful, magical
b. Eastern, holistic
c. Western, biomedical
d. Harmonious, religious

Answer 21

c. Western, biomedical

Question 22

A client of German descent rocks back and forth, grimaces, and rubs both temples. What is the nurse’s best action?

a. Assess the client for extrapyramidal symptoms.
b. Sit beside the client and rock in sync.
c. Offer to pray with the client.
d. Assess the client for pain.

Answer 22

d. Assess the client for pain.

Question 23

A Vietnamese client’s family reports that the client has wind illness. Which menu selection will be most helpful for this client?

a. Iced tea
b. Ice cream
c. Warm broth
d. Gelatin dessert

Answer 23

c. Warm broth

Question 24

A Mexican American client puts a picture of the Virgin Mary on the bedside table. What is the nurse’s best action?

a. Move the picture so it is beside a window.
b. Send the picture to the business office safe.
c. Leave the picture where the client placed it.
d. Send the picture home with the client’s family.

Answer 24

c. Leave the picture where the client placed it.

Question 25

A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence by initially providing what intervention?

a. identifying culture-bound issues.
b. implementing scientifically proven interventions.
c. correcting inferior health practices of the population.
d. exploring commonly held beliefs and values of the population.

Answer 25

d. exploring commonly held beliefs and values of the population.

Question 26

A nurse cares for a first-generation American whose family emigrated from Germany. Which worldview about the source of knowledge would this client likely have?

a. Knowledge is acquired through use of affective or feeling senses.
b. Science is the foundation of knowledge and proves something exists.
c. Knowledge develops by striving for transcendence of the mind and body.
d. Knowledge evolves from an individual’s relationship with a supreme being.

Answer 26

b. Science is the foundation of knowledge and proves something exists.

Question 27

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

a. Clients of different cultural groups may metabolize medications at different rates.
b. Metabolism of psychotropic medication is consistent among various cultural
groups.
c. Differences in hepatic enzymes will influence the rate of elimination of
psychotropic medications.
d. It is important to provide clients with oral and written literature about their
psychotropic medications.

Answer 27

a. Clients of different cultural groups may metabolize medications at different rates.

Question 28

A nurse prepares to assess a newly hospitalized client who moved to the United States 6 months ago from Somalia. What should the nurse initially determine?

a. if the client’s immunizations are current.
b. the client’s religious preferences.
c. the client’s specific ethnic group.
d. whether an interpreter is needed.

Answer 28

d. whether an interpreter is needed.

Question 29

Which questions should the nurse ask to determine an individual’s worldview? (Select all that apply.)

a. What is more important: the needs of an individual or the needs of a community?
b. How would you describe an ideal relationship between individuals?
c. How long have you lived at your present residence?
d. Of what importance are possessions in your life?
e. Do you speak any foreign languages?

Answer 29

a. What is more important: the needs of an individual or the needs of a community?
b. How would you describe an ideal relationship between individuals?
d. Of what importance are possessions in your life?

Question 30

Why is the study of culture so important for psychiatric nurses in the United States? (Select all that apply.)

a. Psychiatric nurses often practice in other countries.
b. Psychiatric nurses must advocate for the traditions of the Western culture.
c. Cultural competence helps protect clients from prejudice and discrimination.
d. Clients should receive information about their illness and treatment in terms they understand.
e. Psychiatric nurses often interface with clients and their significant others over a long period of time.

Answer 30

c. Cultural competence helps protect clients from prejudice and discrimination.
d. Clients should receive information about their illness and treatment in terms they
understand.
e. Psychiatric nurses often interface with clients and their significant others over a long period of time.

Question 31

The nurse should be particularly alert to expression of psychological distress through physical symptoms among clients whose cultural beliefs include (Select all that apply.)

a. mental illness reflects badly on the family.
b. mental illness shows moral weakness.
c. intergenerational conflict is common.
d. the mind, body, and spirit are merged.
e. food choices influence one’s health.

Answer 31

a. mental illness reflects badly on the family.
b. mental illness shows moral weakness.
d. the mind, body, and spirit are merged.