NCLEX Questions for culture, ethnicity and spirituality Flashcards
To include a cultural focus in patient care planning, which belief about faith will the nurse incorporate? Faith is a:
a. Belief of body and mind
b. Manner of expressing spirituality
c. Use of spiritual resources without empiric proof
d. Search for the sacred, transcendent, or universal
C
Faith is the ability to draw on spiritual resources without having physical and empiric proof. Body and mind refer to psychosomatic concepts. A manner of expressing spirituality refers to religion. A search for the sacred, transcendent, or universal refers to spirituality
A culturally diverse patient refuses to participate in a group because of the presence of a person who “can put spells on.” The nurse recognizes a priority need to explore this patient’s:
a. Economic status
b. Home environment
c. Health-illness beliefs
d. Educational background
C
Culture influences beliefs about health and illness, including causes of illness. What the nurse might label as delusional might be a culturally determined belief about illness causation. The other assessments do not relate to the situation as directly.
An Asian-American patient diagnosed with depression explains to the nurse that eating two specific foods will restore the balance of hot and cold and she will be cured. The nurse should:
a. Explain that foods cannot cure mental disorders.
b. Arrange for the patient to talk with the dietitian.
c. Change the subject to focus on medication compliance.
d. Accept that cultural beliefs about illness die slowly.
B
Culturally determined beliefs about health and illness should be respected. If there are no contraindications to the patient eating the foods mentioned, the nurse should facilitate obtaining them. Attempt to explain the flaw in the patient’s belief is an attempt to negate culturally determined beliefs. Changing the subject does not address patient concerns. Assuming that the belief is inflexible suggests the patient’s beliefs have no merit.
When working with a patient newly emigrated from Asia who has been assessed as having xenophobia, the nurse could anticipate making the assessment that the individual:
a. Resists sharing food with others
b. Would be reluctant to ride an elevator
c. Is unlikely to talk with nonfamily members
d. Fears the consequences of going out of doors
C
Xenophobia is defined as a morbid fear of strangers. The xenophobic individual would not necessarily resist sharing food (fear of germs), riding in elevators (fear of closed spaces), or going out of doors (fear of open spaces).
The nurse plans to use pamphlets to teach a newly immigrated Vietnamese patient about diabetes mellitus. Before initiating this education, the priority information for the nurse to obtain is the patient’s:
a. Ability to read and understand English
b. Readiness and ability to learn this material
c. Previous knowledge and interest in the subject
d. Willingness to participate and follow instructions
A
Pamphlets are useful only if the patient can read and understand the language in which the material is written. The other options are secondary to this priority concern.
A nurse is planning to incorporate a culturally sensitive focus in her nursing care. Which of these underlying principles concerning cultural heritage will be included?
a. A group is formed from among individuals who share similar ancestral origins.
b. A condition of belonging to a group is that all members share a unique heritage.
c. Learned patterns of behavior and thinking are shared by members of a cultural group.
d. The classification of humans into cultural groups is generally based on physical characteristics.
C
Cultural heritage is learned patterns of behavior and thinking shared by a particular group that is transmitted over time to other members. Ancestral origins, a similar heritage, and physical characteristics may be shared traits but alone do not constitute cultural heritage.
A patient diagnosed with paranoid schizophrenia is describing religiously-based delusions that other patients find offensive. Which nursing intervention will the nurse implement to provide a therapeutic milieu?
a. Engaging the delusional patient in prayer in order to redirect the problematic behavior
b. Explaining to the delusional patient that such talk is offensive to some of the milieu and will not be allowed
c. Asking for the pastoral counselor to visit the unit and talk with both the delusional patient as well as the rest of the milieu
d. Removing the delusional patient from the milieu when staff is unable to successfully refocus the conversation to a non-religious topic.
C
Occasionally, individuals with serious mental disorders experience delusions that are spiritual or religious in nature. Certified pastoral counselors are skilled with regard to counseling patients and consulting with staff about these problems, and they assist the health care team in ways that address the particular concerns of individual patients. Challenging or debating the truth of a person’s delusions is not therapeutic, and spiritual delusions are no exception. Engaging in spiritual or religious practice with individuals on a psychiatric unit is also inappropriate. Removing the patient from the milieu is seldom therapeutic and done only to maximize milieu safety.
A patient confides to the nurse that she feels guilty about the poor relationship she had with her mother-in-law, who is now deceased. The patient tells the nurse that she is sure God will punish her for this and that she needs to confess her sins to someone. Which of the following is the best response by the nurse?
a. “Would you like to speak to the chaplain when he comes later today? In the meantime, we could talk about your relationship with your mother-in-law.”
b. “It sounds as if you need to talk about this. Let’s sit down in a private area. I’d like to know more about your relationship with your mother-in-law.”
c. “We all have trouble with our in-laws occasionally. God doesn’t punish us for that.”
d. “What’s done is done. We need to focus on your positive qualities.”
A
The patient has identified a specific spiritual problem that a chaplain would be equipped to handle, so a referral is appropriate. The nurse, in the meantime, is equipped to discuss relationship issues. Offering to talk about the relationship without addressing the patient’s expressed spiritual needs is not therapeutic. Suggesting that the patient’s relationship issues are not uncommon minimizes the patient’s feelings. Attempting to refocus the patient dismisses the patient’s needs.
A patient is dealing with the loss of a spouse. Which response shows an understanding of the role spirituality plays in the management of grief?
a. “He’s in a better place; my faith tells me that is true.”
b. “I find that my faith is stronger now that I’m alone.”
c. “I’m told that a sense of spiritual connection will help me go on with life.”
d. “My faith helps me deal and gives me renewed hope; I rely on it to help me heal.”
D
Spirituality allows one to cope with these feelings by providing a sense of hope and meaning to experiences that would otherwise be crippling. Spirituality is often a key component in the healing process, and it is an integral part of the patient’s treatment plan. The remaining options do not as directly deal with the patient’s personal loss and the progression to healing.
The nurse identifies a patient as being in spiritual distress. Which patient statement supports this nursing diagnosis?
a. “I’ve never felt so alone before in my entire life.”
b. “I don’t know if I could get through this without faith in God.”
c. “I’ve always relied on my faith in God but now I feel I’ve been abandoned.”
d. “Why do bad things happen to good people? I’ve always been a good person.”
C
Spiritual distress is a nursing diagnosis that is defined as a disruption in the value and belief systems that pervades the person’s state of being and that transcends the physical and psychosocial self. Feeling abandoned when one has always relied on faith is an indication of spiritual distress. Feeling alone and questioning why something has occurred is not necessarily spirit based, and not an indication of spiritual distress. Questioning one’s ability to manage an emotion without one’s faith is a testimony to the faith, not an expression of despair.
Assessment of interpersonal relationships of Asian and Asian-American patients is dependent on the nurse’s understanding that the culture of these patients is identified as high context and will therefore value:
a. Privacy; family is not routinely included in health discussions
b. Their right to make independent decisions about their care
c. Sharing their opinions and wishes with healthcare team
d. Their role and place in their family structure
D
Asian and Asian-American patients have been socialized into high-context cultures in which there is collective identity, group decision making, emotional dependence, deference to those of higher status and age, and use of indirect language to communicate. The remaining options are characteristic of low-context cultures.
Which communication behavior would be considered uncharacteristic for a patient from a high-context culture?
a. Little direct eye contact
b. Use of global messages
c. Use of nonverbal symbolization
d. Arguing points with the physician
D
Arguing to get a point across is more characteristic of the communication of a person from a low-context culture. A person from a high-context culture would not be expected to dispute a person with authority. The person from a high-context culture would be expected to use global communication and nonverbal symbolization but to make little direct eye contact.
An Asian-American patient is referred to the mental health clinic. He has many somatic complaints for which no physical basis has been found. The patient tells the nurse that he does not believe this clinic can help him. Based on knowledge of the beliefs common to this culture, what can the nurse hypothesize about the patient?
a. Because of the cultural stigma attached to mental illness, he may be expressing psychological distress via somatic symptoms.
b. Acculturation has occurred because feelings of hopelessness are alien to his native culture.
c. Suicide is not a present danger because suicidal impulses are rarely associated with feelings of helplessness among Asian-American patients.
d. The patient has rejected both family care and traditional healing methods in favor of health care practices of the new culture.
A
The following facts are known about beliefs commonly held by members of this culture: there is a stigma attached to mental illness; mental illness is often described in somatic terms; members of this culture come into treatment late and often have feelings of hopelessness upon entry into the system; families tend to care for their members with mental illness; and traditional healing has usually been tried and failed before the patient attempts to access the mental health system.
The nurse determines which patient is at the greatest risk for a spiritual crisis?
a. A patient, whose religion opposes the use of blood products, has a severely bleeding ulcer
b. A single parent who must decide to terminate life support for a terminally ill child
c. A newlywed whose spouse has died in an automobile accident caused by a drunk driver
d. A patient who denies the need for spiritual support when given the diagnosis of terminal cancer.
A
A spiritual crisis may occur when religious or spiritual beliefs conflict with a necessary procedure or a treatment protocol, such as permitting a blood transfusion. Although the remaining options all present with a serious emotional situation, there is no evidence to support that the patient’s beliefs are being challenged.
The nurse believes that a patient is exhibiting internal locus of control related to spiritual development. Which patient statement supports this conclusion?
a. “Praying gives me tremendous comfort.”
b. “I pray because my church says that prayer is the way to God”
c. “I will ask that my fellow church members pray for me to get better.”
d. “My mother prayed daily and she was such a good and kind person.”
A
During development, one’s sense of faith, meaning moral values, and judgment moves from an external locus of control to an internal locus of control. An example of such internal control is the expressed feeling of comfort derived from prayer. The remaining options reflect external locus of control since each is an expression of how beliefs about prayer are provided by others; church doctrine and the faith of others.
