Tabloski Gerontological Nursing, 3/eChapter 04
Question 1
Type: MCSA
The charge nurse is made aware that a 96-year-old patient does not want to be cared for by African Americans. What does this patient's attitude exemplify?
1. Culture
2. Ethnicity
3. Life trajectory differences
4. Complexity of the Cultural Care triad
Correct Answer: 4
Rationale 1: Culture has many definitions and reflects racial, ethnic, religious, or social groups. This patient's attitude demonstrates more than the patient's culture.
Reference: Page 78
Rationale 2: Ethnicity pertains to a social group within the social system that claims to possess variable traits.
Reference: Page 78
Rationale 3: Life trajectory is the experiences of an individual's life and can differ among individuals.
Reference: Page 78
Rationale 4: The patient's age would indicate that the patient was born during a time when racial bias was acceptable. Although the nurse may not possess the same racial bias, this circumstance illustrates the complexity of the Cultural Care triad, where the nurse, patient, and caregiver come from diverse backgrounds, ethnicities, and life experiences.
Reference: Page 78
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2. Apply the Cultural Care triad to the complex interrelationships of the nurse, caregiver, and patient within community and institutional (home or residential) settings.
Question 2
Type: MCSA
The husband of a female patient of the Islamic culture asks that only a female doctor examine his wife. How should the nurse respond to the husband?
1. A female doctor will be provided.
2. The request is unreasonable and cannot be honored.
3. Both male and female doctors respect the patient's privacy.
4. The patient's body will be covered during any examinations.
Correct Answer: 1
Rationale 1: A common cultural conflict is misunderstanding a cultural practice of modesty and the need for gender-specific care. The nurse should recognize this as a legitimate request and make every attempt to honor the request.
Reference: Page 89
Rationale 2: Stating that the request is unreasonable shows insensitivity to the patient's cultural need.
Reference: Page 89
Rationale 3: Although both male and female staff has professional and ethical responsibilities to respect a patient's privacy, the nurse must still make efforts to meet the request of the patient.
Reference: Page 89
Rationale 4: The response of covering the patient shows insensitivity to the patient's cultural need.
Reference: Page 89
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 3
Type: MCSA
The nurse learns that a patient of the Jewish faith does not eat certain types of foods and fasts on religious holidays. What should the nurse do to ensure that this patient's needs are met?
1. Report the patient's needs to the oncoming nurse.
2. Document the patient's preferences on the assessment form.
3. Talk with the dietitian to obtain food preferences for the patient's meals.
4. Explain to the patient that eating is needed to maintain nutritional status.
Correct Answer: 3
Rationale 1: The nurse needs to do more than report the patient's needs to the oncoming nurse.
Reference: Page 88
Rationale 2: The nurse needs to do more than documenting the patient's preferences on the assessment form.
Reference: Page 88
Rationale 3: Talking with the dietitian to obtain food preferences for the patient's meals meets the patient's needs.
Reference: Page 88
Rationale 4: Trying to convince the patient to not follow cultural or religious beliefs demonstrates cultural insensitivity on the part of the nurse.
Reference: Page 88
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 4
Type: MCSA
An infant of African origin is being cared for by parents who immigrated to the United States 6 months prior. The mother is using an herbal paste to treat the baby's diaper rash. What should the nurse do to ensure cultural competence?
1. Instruct the mother to stop using the paste.
2. Ask the mother to explain the ingredients in the paste.
3. Provide the mother with another cream to use for the diaper rash.
4. Explain to the mother that herbal ingredients are harmful to the baby.
Correct Answer: 2
Rationale 1: Instructing the mother to stop using the paste demonstrates cultural insensitivity by the nurse and should not be done.
Reference: Page 88
Rationale 2: To recognize cultural practices, the nurse must acknowledge that use of folk and home remedies are part of caregiving practices. Asking the mother what ingredients are in the paste allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner.
Reference: Page 88
Rationale 3: Providing the mother with another cream to use for the diaper rash demonstrates cultural insensitivity by the nurse and should not be done.
Reference: Page 88
Rationale 4: Explaining to the mother that herbal ingredients are harmful to the baby demonstrates cultural insensitivity by the nurse and should not be done.
Reference: Page 88
Global Rationale:
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 4. Describe the value and process of heritage and life trajectory assessments of nurses, caregivers, and patients.
Question 5
Type: MCMA
A patient of the Latino culture is recovering from surgery and has not requested any pain medication. What should the nurse include when assessing this patient for pain?
Standard Text: Select all that apply.
1. Does pain indicate that death is near?
2. What is the patient's cultural perspective towards pain?
3. Does the patient believe that pain is punishment for past behaviors?
4. What are the socially acceptable behaviors of pain in the patient's culture?
5. Is experiencing pain an expected part of living within the patient's culture?
Correct Answer: 2,3,4
Rationale 1: The nurse needs to understand the patient's beliefs about pain. Death and dying is another category of beliefs and is not included within the category of pain.
Reference: Page 88
Rationale 2: The nurse needs to understand the patient's beliefs about pain. One area to assess is the patient's cultural perspective towards pain.
Reference: Page 88
Rationale 3: The nurse needs to understand the patient's beliefs about pain. One area to assess is if the patient believes that pain is punishment for past behaviors.
Reference: Page 88
Rationale 4: The nurse needs to understand the patient's beliefs about pain. One area to assess is the socially acceptable behaviors of pain within the patient's culture.
Reference: Page 88
Rationale 5: The nurse needs to understand the patient's beliefs about pain. Asking if pain is an expected part of living within the patient's culture is not a part of the pain assessment.
Reference: Page 88
Global Rationale:
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Create a plan of care for the older adult integrating Cultural Care.
Question 6
Type: MCSA
The family of a 95-year-old patient of the Chinese culture is planning on caring for the patient in the home. How can the nurse best meet the patient's needs?
1. Discussing how other families have approached this problem
2. Explaining to the family that resources are available to help the patient
3. Exploring the resources the family has to meet the patient’s needs in its home
4. Insisting that the family reconsider its decision and look at other care options
Correct Answer: 3
Rationale 1: Comparing the family to other families of different cultural backgrounds does not recognize the cultural aspects of this patient and the family.
Reference: Page 89
Rationale 2: Expressing personal judgment of what is a burden to the family does not recognize the cultural aspects of this patient and the family.
Reference: Page 89
Rationale 3: Helping the family explore resources to meet the patient's needs is the best method to respect the tradition of the cultural background of this patient and family.
Reference: Page 89
Rationale 4: Insisting the family break tradition and look at other care options does not recognize the cultural aspects of this patient and the family.
Reference: Page 89
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 7
Type: MCMA
An older patient is refusing a prescribed course of treatment because it goes against religious principles. The nurse realizes that religion plays what role within ethnocultural heritage?
Standard Text: Select all that apply.
1. Provides a system of practices
2. Provides a meaningful philosophy
3. Gives the patient a frame of reference
4. Conducive to spiritual harmony and health
5. Increases morbidity and mortality of older patients
Correct Answer: 1,2,3,4
Rationale 1: A component of a person's heritage is religion, which provides a system of practices.
Reference: Page 81
Rationale 2: A component of a person's heritage is religion, which provides a meaningful philosophy about health.
Reference: Page 81
Rationale 3: A component of a person's heritage is religion, which gives the patient a frame of reference.
Reference: Page 81
Rationale 4: A component of a person's heritage is religion, which is conducive to spiritual harmony and health.
Reference: Page 81
Rationale 5: Evidence shows that religion helps to decrease morbidity and mortality in older patients.
Reference: Page 81
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 8
Type: MCMA
The nurse is caring for an older patient who only speaks Spanish. To meet the national standards for culturally and linguistically appropriate services in healthcare, what will the nurse do?
Standard Text: Select all that apply.
1. Offer language assistance services to the patient.
2. Post signs in the patient's room written in Spanish.
3. Encourage the patient's family members to serve as interpreters.
4. Explain the cost to employ an interpreter to help the patient with language needs.
5. Provide a written notice in the patient's language informing of the right to receive language assistance services.
Correct Answer: 1,2,5
Rationale 1: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to offer language assistance services to the patient.
Reference: Page 77
Rationale 2: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to post signage in the patient's native language.
Reference: Page 77
Rationale 3: Family should not be used to provide interpretive services except upon request by the patient.
Reference: Page 77
Rationale 4: Healthcare organizations must offer and provide language assistance services at no cost to each patient.
Reference: Page 77
Rationale 5: To meet the national standards for culturally and linguistically appropriate services, the nurse needs to provide the patient with a written notice in the patient's language, informing the patient of the right to receive language assistance services.
Reference: Page 77
Global Rationale:
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 9
Type: MCMA
An older patient from an Asian background is refusing to eat. What are the consequences if the patient continues to avoid eating?
Standard Text: Select all that apply.
1. Hostility
2. Depression
3. Weight loss
4. Withdrawal
5. Dehydration
Correct Answer: 3,5
Rationale 1: Refusing to eat will not lead to the patient demonstrating hostility.
Reference: Page 89
Rationale 2: Refusing to eat will not lead to the patient demonstrating depression.
Reference: Page 89
Rationale 3: Refusing to eat will lead to the patient outcome of weight loss.
Reference: Page 89
Rationale 4: Refusing to eat will not lead to the patient demonstrating withdrawal.
Reference: Page 89
Rationale 5: Refusing to eat will lead to the patient outcome of dehydration.
Reference: Page 89
Global Rationale:
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3. Identify potential areas of conflict derived from the demographic, ethnocultural, and life trajectory variables of the people within the triad.
Question 10
Type: MCMA
While conducting an assessment, the nurse learns that an older patient from a European country practices heritage consistency. What did the nurse assess in this patient?
Standard Text: Select all that apply.
1. The patient's name has not been Americanized.
2. The patient attended social activities at the church.
3. The patient does not participate in any cultural events.
4. The patient has returned to the mother land several times.
5. The patient immigrated to the United States as a young adult.
Correct Answer: 1,2,4,5
Rationale 1: A factor that indicates heritage consistency is the patient's name has not been Americanized.
Reference: Page 82
Rationale 2: A factor that indicates heritage consistency is attending social activities at the church.
Reference: Page 82
Rationale 3: A factor that indicates heritage consistency is participating in cultural events.
Reference: Page 82
Rationale 4: A factor that indicates heritage consistency is returning to the old country.
Reference: Page 82