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Psychiatric Nursing 5th Edition Keltner Schwecke Test Bank
ISBN-13: 978-0323039062
ISBN-10: 0323039065
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Keltner: Psychiatric Nursing, 5th Edition
Test Bank
Chapter 14: Cultural Competence in Psychiatric Nursing
MULTIPLE CHOICE
- A UAP (unlicensed assistive personnel) tells the nurse, “I hear all the staff talking about cultures. Can you explain what culture is?” The best response for the nurse would be, “Culture is a group’s shared:
| a. | ethnicity.” |
| b. | values, beliefs, and norms.” |
| c. | biologic variations and psychological characteristics.” |
| d. | patterned behavioral responses that develop over time.” |
ANS: B
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. Each is narrow in scope.
Cognitive level: Application
See text page(s): 164 OBJECTIVE: NA
Nursing process: Implementation Topic: Culture
AACN: Communication; Human Diversity; Manager of Care
NCLEX: Safe, Effective Care Environment
NLNAC: Community Concepts
- A nurse has been assigned to work in an agency setting that provides care to members of the community belonging to a minority ethnic population. The nurse will be better able to demonstrate cultural competence when:
| a. | trained and proficient in self-defense measures. |
| b. | implementing scientifically proven interventions. |
| c. | correcting the inferior health practices of the population. |
| d. | he or she has explored beliefs and values commonly held this minority population. |
ANS: D
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.
Cognitive level: Application
See text page(s): 164-165 OBJECTIVE: 2
Nursing process: Implementation Topic: Cultural Competence
AACN: Technical Skills; Human Diversity; Manager of Care
NCLEX: Safe, Effective Care Environment
NLNAC: Community Concepts
- A patient is a first-generation American; his family immigrated from Germany a generation ago. The nurse conducting a cultural assessment would expect to find that the patient’s worldview included the belief that knowledge is developed:
| a. | through the affective or feeling senses. |
| b. | in striving for transcendence of the mind and body. |
| c. | based on the individual’s relationship with a supreme being. |
| d. | according to proof of something’s existence based on being able to confirm it with one’s senses. |
ANS: D
Option 4 describes the European-American perspective of acquiring knowledge. Option 1 reflects African, Hispanic, and Arabic worldviews of knowledge, option 2 reflects Asian and Polynesian worldviews, and option 3 reflects the Native-American worldview.
Cognitive level: Application
See text page(s): 167 OBJECTIVE: 4
Nursing process: Assessment Topic: European-American Worldview
AACN: Assessment; Human Diversity; Manager of Care
NCLEX: Safe, Effective Care Environment
NLNAC: Community Concepts
- The patient most likely to hold the worldview that every person is good and has no evil within is someone who is:
| a. | Polynesian. |
| b. | Native American. |
| c. | Hispanic American. |
| d. | Asian or Asian American. |
ANS: B
The Native-American perspective of logic holds that every person is innately good and devoid of evil within. The other groups see the mind and body as existing independently of the physical world or believe that reasoning ability is based on the union of opposites.
Cognitive level: Application
See text page(s): 167 OBJECTIVE: 4
Nursing process: Assessment Topic: Native-American Worldview
AACN: Assessment; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- To assess the interpersonal relationships of patients of different cultures adequately, the nurse must understand that placing value on the balance within member-group interactions is a part of the worldview of:
| a. | Native Americans. |
| b. | Hispanic Americans. |
| c. | Asians and Asian Americans. |
| d. | Africans and African Americans. |
ANS: C
The perspective of Asians and many members of an Asian-American cultural group is grounded in the belief that everyone and everything in the physical and spiritual world are related, and value is placed on the balance within member-group interactions. The good of the group is considered more important than what is good for the individual. The groups mentioned in the other options have differing values, not consistent with what is mentioned in the scenario.
Cognitive level: Comprehension
See text page(s): 167 OBJECTIVE: 4
Nursing process: Assessment Topic: Asian Worldview
AACN: Assessment; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- A nurse working in the alternative therapy clinic determines that patients come to the clinic seeking acupuncture, nutritional therapies, moxibustion, cupping, and coining to restore:
| a. | chi. |
| b. | meridians. |
| c. | equilibrium. |
| d. | energy vectors. |
ANS: C
Patients who view illness as disequilibrium, or lack of balance, seek alternative treatment to restore balance. Chi is an energy force. Meridians are lines in the body representing body functions. Energy vectors is not a legitimate concept.
Cognitive level: Comprehension
See text page(s): 169 OBJECTIVE: 3
Nursing process: Assessment Topic: Alternative Therapy: Purpose
AACN: Assessment; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- Many Mexican Americans believe in mal ojo (evil eye), a condition that affects infants and children. During a cultural assessment, the nurse can expect to learn that the mother of a child with mal ojo believes that the effects of the spell can be broken after:
| a. | ignoring the child. |
| b. | blessing the child. |
| c. | looking deeply into the child’s eyes. |
| d. | a root doctor or native healer intervenes. |
ANS: D
Individuals who believe in culture-bound illnesses usually also believe that the cure for the illness is found in treatment a native healer or roots doctor. The mother would not believe that any of the other options are effective.
Cognitive level: Application
See text page(s): 168-169 OBJECTIVE: 6
Nursing process: Assessment Topic: Culture-Bound Syndromes
AACN: NA; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- The Mexican mother of a 3-month-old babrings the bato the mental health clinic, saying that an old woman gave the bathe evil eye. The nurse finds nothing physically wrong with the baby. The most culturally competent intervention would be to:
| a. | tell the mother that the child is fine and needs no treatment. |
| b. | provide a short course of broad-spectrum antibiotic therapy. |
| c. | explain that the evil eye is a superstition, not a real cause of illness. |
| d. | bring a root doctor into the consultation to treat the child. |
ANS: D
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 a native healer who can remove the spell. The mother would not view offering no treatment or casting doubt on evil eye as a superstition as helpful, making these options culturally insensitive. The other option is unnecessary and inappropriate.
Cognitive level: Analysis
See text page(s): 168-169 OBJECTIVE: 5
Nursing process: Implementation Topic: Culture-Bound Syndrome
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- A visitor from Cuba is admitted for acute depression. In talking with the patient and the relatives he is visiting, the nurse determines that the patient has a relational worldview. The priority implication for planning is:
| a. | the nurse will need to clear interventions with the oldest woman in his family, who is the predominant family decision maker. |
| b. | the nurse will want to consult with the family and even religious advisors to plan care. |
| c. | the patient will wish to use meditation and contemplation techniques as part of treatment. |
| d. | Western medical treatment will be readily accepted the patient. |
ANS: B
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 other options reflect alternative worldviews.
Cognitive level: Analysis
See text page(s): 165-166 OBJECTIVE: 5
Nursing process: Planning Topic: Cultural Competence
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- A psychiatric patient comes to a clinic appointment carrying her baby. The nurse notes several skin abrasions on the baby’s thighs and assesses that skin scraping has been used. In an effort to use cultural negotiation, the nurse should:
| a. | show the mother how to use moxibustion rather than skin scraping. |
| b. | explain that skin scraping doesn’t effectively treat illness and tell the mother not to use it. |
| c. | explain that the scraped skin can become infected and that scraping should not be done. |
| d. | suggest that less pressure be used during scraping to prevent abrasions and subsequent infections. |
ANS: D
Cultural negotiation is the nurse’s ability to work within a patient’s cultural belief system to develop culturally appropriate interventions. Only 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.
Cognitive level: Analysis
See text page(s): 170 OBJECTIVE: 5
Nursing process: Implementation Topic: Cultural Negotiation
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Physiological Integrity NLNAC: Therapeutic Interventions
- A psychiatric nurse is to administer alprazolam (Xanax) to a Japanese-American patient for the first time. The order reads Xanax, 0.25 to 1 mg PO, prn for anxiety. The most appropriate dose for the nurse to give is:
| a. | 1 mg. |
| b. | 0.75 mg. |
| c. | 0.50 mg. |
| d. | 0.25 mg. |
ANS: D
The smallest dose is the safest initial dose. Asian individuals might be particularly sensitive to psychotropic medication based on genetic metabolic differences, so a smaller dose achieves a therapeutic effect without side effects and untoward effects.
Cognitive level: Analysis
See text page(s): 169-170 OBJECTIVE: 7
Nursing process: Implementation Topic: Ethnopharmacology
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Physiological Integrity NLNAC: Therapeutic Interventions
- A young Hispanic woman comes to the clinic saying that she has no energy, can’t eat, and wants to sleep, but can’t. She experiences vague shifting pains at various locations in her body and sometimes has GI disturbances. The physical examination reveals no pathology. The nurse should hypothesize that the patient might be experiencing:
| a. | lost soul (susto). |
| b. | evil eye. |
| c. | broken heart. |
| d. | amok. |
ANS: A
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.
Cognitive level: Analysis
See text page(s): 168-169 OBJECTIVE: 6
Nursing process: Assessment Topic: Culture-Bound Syndromes
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Critical Thinking
- A young Hispanic woman comes to the clinic saying that she has no energy, can’t eat, and wants to sleep, but can’t. She experiences vague shifting pains at various locations in her body and sometimes has GI disturbances. The physical examination reveals no pathology. The nurse suspects that these symptoms are indicative of a depressive illness expressed in a culturally specific manner. With this in mind, the nurse should consider that use of a selective serotonin reuptake inhibitor (SSRI) might be more effective if combined with:
| a. | treatment a traditional healer. |
| b. | acupuncture. |
| c. | skin scraping. |
| d. | moxibustion. |
ANS: A
Lost soul is 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. Therefore, 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.
Cognitive level: Analysis
See text page(s): 168-169 OBJECTIVE: 6
Nursing process: Planning Topic: Culture-Bound Illness
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Critical Thinking
- An 8-month-old Chinese-American child is seen in a well-baclinic. The mother is a psychiatric outpatient who tells the nurse that the bais fussy and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. The most appropriate intervention would be to:
| a. | ask if the mother has used coining. |
| b. | report the mother for child abuse. |
| c. | realize that the mother has taken the child to an acupuncturist. |
| d. | contact the psychiatric clinic to find out whether the mother has expressed a desire to harm the child. |
ANS: A
Recognition of the characteristic marks of coining or skin scraping can help the nurse from making a culturally insensitive judgment that child abuse is occurring. Coining is used Asian families to restore equilibrium for babies and small children. The other options would be inappropriate or ineffective.
Cognitive level: Application
See text page(s): 169 OBJECTIVE: 5
Nursing process: Implementation Topic: Culture-Bound Mental Health Issues
AACN: NA; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Therapeutic Interventions
- A patient from Haiti wears a small bag around the neck. The nurse determines that the patient believes that the bag’s contents ward off illness and bad luck. The nurse decides during the admission interview to permit the patient to keep the bag while hospitalized. The nurse is practicing cultural:
| a. | negotiation. |
| b. | preservation. |
| c. | repatterning. |
| d. | diversity. |
ANS: B
Cultural preservation is the nurse’s ability to acknowledge, value, and accept a patient’s cultural beliefs. The scenario does not present data relating to or suggesting any other option.
Cognitive level: Application
See text page(s): 170 OBJECTIVE: 5
Nursing process: Implementation Topic: Cultural Preservation
AACN: NA; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- The nurse reads in the patient’s record that a mother who believes that her child is suffering from mal ojo has not given the child the medication prescribed for otitis media. The nursing diagnosis of noncompliance has been identified the nurse who saw the child last. The present nurse, who is culturally competent, would analyze the situation as occurring because of:
| a. | differing perceptions of how illness occurs. |
| b. | lack of knowledge of therapeutic regimen. |
| c. | unconscious hostility toward the child. |
| d. | a need to involve child protective services. |
ANS: A
A mother who believes that the child’s illness is to 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.
Cognitive level: Analysis
See text page(s): 170 OBJECTIVE: 5
Nursing process: Nursing Diagnosis Topic: Culture-Bound Syndrome
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Critical Thinking
- A nurse who is assigned to teach a medication education group for psychiatric outpatients holds an analytic worldview. He routinely relies heavily on pamphlets as primary teaching tools. His habit is to enter the room and move quickly into teaching content. The patients in the group are primarily Hispanic. At the end of the teaching session, the patients are most likely to believe that:
| a. | the teaching was efficient. |
| b. | the nurse was uncaring. |
| c. | they were treated respectfully. |
| d. | the session was effective. |
ANS: B
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 other of the other views.
Cognitive level: Analysis
See text page(s): 165-166 OBJECTIVE: 4
Nursing process: Evaluation Topic: Differing Worldviews
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Critical Thinking
- A Chinese-American woman being treated for severe depression has a nurse case manager who is male. The nurse will need to be particularly attentive to making sure that the patient:
| a. | understands the therapeutic regimen. |
| b. | is willing to follow directions for medication use. |
| c. | does not harbor homicidal thoughts toward her husband. |
| d. | observes cultural norms for eating hot and cold foods. |
ANS: A
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. Asian Americans are no more prone to homicidal thoughts than others. Although hot and cold foods might be used Asian Americans, there is no evidence that this patient is interested in this therapy.
Cognitive level: Analysis
See text page(s): 165-166 OBJECTIVE: 3
Nursing process: Implementation Topic: Worldviews
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Critical Thinking
- A nurse is assigned to an outreach program on a Native-American reservation. The communication pattern that will be most effective to use is that:
| a. | silence is considered a social error. |
| b. | touching is considered an accepted part of conversation. |
| c. | important topics are always preceded polite social conversation. |
| d. | rules regarding roles and status are important and must be observed. |
ANS: D
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 tribal elders, healers, and others perceived to be in positions of importance. The other options are not consistent with ecologic worldview.
Cognitive level: Application
See text page(s): 166-168 OBJECTIVE: 3
Nursing process: Implementation Topic: Worldviews
AACN: Communication; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
- A nurse looks at the clinic schedule and sees that he is scheduled to interview a new patient, a Muslim college professor from the Middle East, shortly after lunch. An action that would support cultural competence would be for the nurse to:
| a. | not eat pork. |
| b. | review Middle Eastern culture. |
| c. | determine if a translator is available. |
| d. | remember not to offer to shake hands. |
ANS: B
Brushing up on Middle Eastern culture would be a sensitive action that might result in a lowering of barriers between the nurse and patient. Although Muslims do not eat pork, it would not be necessary for the nurse to abstain. A translator would probably note be needed if the patient is a college professor. Shaking hands with Middle Easterners is not inappropriate.
Cognitive level: Application
See text page(s): 164-165 OBJECTIVE: 5
Nursing process: Implementation Topic: Cultural Competence
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
MULTIPLE RESPONSE
- Which of the following questions should the nurse ask when attempting to determine an individual’s worldview? (Select all that apply.)
| a. | Do you think that the needs of the individual are more important than the needs of the community? |
| b. | Of what importance are possessions in your life? |
| c. | How long have you lived where you presently live? |
| d. | What do you believe is the ideal relationship between individuals? |
| e. | What would be the ideal relationship between humans and nature? |
| f. | Do you speak any foreign languages? |
ANS: A, B, D
The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine whether the worldview of the individual is analytic, relational, community, or ecologic. Other follow-up questions would be needed to validate findings. The other questions provide less information for making the determination.
Cognitive level: Analysis
See text page(s): 166-168 OBJECTIVE: 4
Nursing process: Assessment Topic: Assessment of Worldview
AACN: Critical Thinking; Human Diversity; Manager of Care
NCLEX: Psychosocial Integrity NLNAC: Community Concepts
