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Chapter 05: Cultural Influences
Meiner: Gerontologic Nursing, 5th Edition
MULTIPLE CHOICE
1.A postmenopausal black woman who has been experiencing uterine bleeding tells the nurse, “I expect I’ll need a total hysterectomy because when my sister had this problem that’s what she had done.” The nurse recognizes that this woman belongs to a cultural subgroup whose health care beliefs are most influenced by the:
| a. | biomedical model. |
| b. | magico-religious model. |
| c. | balance/harmony model. |
| d. | personal experience. |
ANS: A
The patient shows a tendency to identify with the biomedical model, which views the body as a functioning machine. When a part gives out or is functioning abnormally, traditional Western medical treatment is sought and expected. The magico-religious models believe that health is a reward from a higher power. The balance/harmony models state that illness is the result of a state of imbalance in body energies. Personal experience influences all of these models.
DIF: Understanding (Comprehension) REF: Page 91 OBJ: 5-5
TOP: Nursing Process: Assessment MSC: Psychosocial Integrity
2.A Hispanic patient explains that the Hispanic culture believes that dietary management would be just as effective in managing her problems as medication, so the patient’s prescription has not been filled. Which action by the nurse illustrates cultural accommodation?
| a. | Asking the patient to give more details regarding this belief |
| b. | Discussing how to add dietary preferences into the treatment plan |
| c. | Offering to have a registered nutritionist discuss the situation with the patient |
| d. | Researching the patient’s proposed dietary beliefs |
ANS: B
Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture adapt to or negotiate with others for a beneficial or satisfying health outcome. The nurse can ask the patient to share more about beliefs, offer a consultation with a nutritionist, or research the beliefs, but these actions do not show accommodation.
DIF: Applying (Application) REF: N/A OBJ: 5-9
TOP: Caring MSC: Psychosocial Integrity
3.A geriatric nurse practitioner working with a tribe of Native Americans makes the decision to acculturate in an attempt to provide culturally appropriate care. The nurse does this best by:
| a. | living the values of the tribe. |
| b. | researching the tribe’s belief systems. |
| c. | learning the language of the tribe. |
| d. | residing among the tribe members. |
ANS: A
Acculturation is a process that occurs when a member of one cultural group adopts the values, beliefs, expectations, and behaviors of another group, usually in an attempt to become recognized as a member of the group. The other actions might be helpful in acculturating.
DIF: Applying (Application) REF: N/A OBJ: 5-3
TOP: Nursing process: Implementation MSC: Psychosocial Integrity
4.The nurse in an assisted living facility is practicing a form of cultural bias called ethnocentrism when:
| a. | requesting the bridge group only use the game room for 2 hours at a time. |
| b. | encouraging Christian residents to attend mass or church services. |
| c. | repeatedly confiscating herbs and food products used in healing. |
| d. | telling potential patients who are Jewish that the facility does not have a kosher kitchen, |
ANS: C
Ethnocentrism is a belief that one’s own cultural group is superior to that of another’s. In nursing we have a unique culture and expect our patients to adapt to us rather than attempting to adapt to the culture of the patient. Confiscating items used in healing rituals shows ethnocentrism and disrespect to the resident. Limiting activities in a group room, encouraging people to attend church services of their religion, and letting prospective Jewish residents know that the facility does not have a kosher kitchen are not examples of ethnocentrism.
DIF: Applying (Application) REF: N/A OBJ: 5-6
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity
5.While caring for an older Korean patient, the nurse notes that the patient answers questions regarding health history when asked but is otherwise silent and does not maintain eye contact. Being culturally sensitive, the nurse recognizes that the patient’s actions are most likely a(n):
| a. | sign of respect for the wisdom and expertise of the nurse. |
| b. | indication that he has no questions regarding the care he is receiving. |
| c. | expression of discomfort discussing personal matters. |
| d. | means of communicating his dissatisfaction with his care. |
ANS: A
Asian cultures generally view eye contact as rude and are often passive in their care. The patient may or may not have further questions. It is not a sign of discomfort or dissatisfaction.
DIF: Remembering (Knowledge) REF: Page 93 OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
6.The culturally sensitive nurse will recognize that an older adult patient with a high-context ethnic background will appreciate:
| a. | not having a treatment scheduled during a favorite television program. |
| b. | both a written and verbal explanation describing how to monitor her blood sugar levels. |
| c. | a concise explanation as to why her physical therapy appointment has been canceled. |
| d. | having a conversation about her grandchildren while her dressing is changed. |
ANS: D
The interactional patterns of high-context (universalism) patients refer to the characteristics of relationships and behaviors toward others. When a person from a high-context culture interacts with the nurse, a more personal relationship is expected. This is not related to television shows, teaching materials, or appointment cancellations.
DIF: Understanding (Comprehension) REF: Page 92 OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
7.In an attempt to be sensitive to varying cultural responses to touch, before shaking a patient’s hand, the nurse will:
| a. | offer the patient his or her upturned palm. |
| b. | wait until the patient extends his or her hand. |
| c. | establish eye contact with the patient first. |
| d. | address the patient by his or her full name. |
ANS: B
The best way to show respect and implement the appropriate response is to follow the lead of the patient by waiting for the patient to extend a hand.
DIF: Applying (Application) REF: N/A OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
8.A older Asian patient receiving physical therapy after hip surgery has developed a low-grade fever. The patient explains that the fever will lessen if the treatment includes the principles of yin/yang. The nurse expects to support the patient by:
| a. | providing privacy when his shaman visits. |
| b. | arranging for his diet to include cold foods and liquids. |
| c. | planning his physical therapy so it does not conflict with meditation. |
| d. | keeping a magical amulet under his pillow. |
ANS: B
The yin/yang theory proposes that health is a result of balance within the body. A principle of this theory is that an illness is either hot or cold and must be treated by elements of the opposite state in order to put the system back into balance. It is not related to shaman visits, meditation, or amulets.
DIF: Applying (Application) REF: N/A OBJ: 5-9
TOP: Caring MSC: Psychosocial Integrity
9.The nurse in an assisted living facility is preparing to admit an older adult patient who speaks very little English. The nurse decides that it is most important that an interpreter be present when the patient:
| a. | indicates a desire to talk with the physician. |
| b. | is being oriented to the facility. |
| c. | is required to sign official documents. |
| d. | begins crying and is inconsolable. |
ANS: C
The more complex the decision making, the more important it is to have an interpreter present. Although all situations would benefit from an interpreter, the most important time is when the patient is signing official documents that have legal implications.
DIF: Applying (Application) REF: N/A OBJ: 5-8
TOP: Communication and Documentation MSC: Psychosocial Integrity
10.When attempting to provide culturally sensitive care according to the explanatory model, the nurse asks the patient:
| a. | “Who will be able to help you when you go home?” |
| b. | “Do you think the treatment is helping?” |
| c. | “When did you first notice the problem?” |
| d. | “Has this illness changed your life?” |
ANS: D
The gerontologic nurse uses this model to explore the meaning of the health problem from the patient’s perspective.
DIF: Applying (Application) REF: N/A OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
11.The nurse is caring for an older adult patient in need of hospitalization. The nurse is aware this patient is a member of an ethnic group that holds a collectivist perspective on community. The nurse best addresses the patient’s medical needs by:
| a. | calling an interpreter to assure the patient is making an informed decision. |
| b. | assuring the patient that his spiritual advisor will meet him at the hospital. |
| c. | arranging for admission to a hospital that is familiar with this patient’s culture. |
| d. | offering to phone the patient’s family and ask them to come in and discuss the hospitalization. |
ANS: D
People with a collectivist perspective derive their identity from affiliation with and participation in a social group such as a family or clan. The needs of the group are more important than those of the individual, and decisions are made with consideration of the effect on the whole. Health care decisions may be made by a group (such as the tribal elders) or a group leader (such as the oldest son). The other options may or may not be needed depending on the specifics of the patient’s case.
DIF: Applying (Application) REF: N/A OBJ: 5-9
TOP: Caring MSC: Psychosocial Integrity
12.The nurse is most effectively using the concept of future time orientation when:
| a. | promising to help the patient call his daughter each weekend. |
| b. | offering to complete the health assessment history after the patient eats dinner. |
| c. | encouraging an older patient to keep a follow-up clinic appointment. |
| d. | arranging for a colorectal cancer screen for senior citizens. |
ANS: D
In the concept of future orientation, people accept the idea that what is done now affects future health. This means that health screenings will help detect a problem today for potentially better health at a later time, days, weeks, or years ahead; it means that prevention may be worth pursuing. The other actions do not show a future orientation.
DIF: Applying (Application) REF: N/A OBJ: 5-9
TOP: Caring MSC: Psychosocial Integrity
13.The student learns that which of the following is the best definition of culture?
| a. | A group of similarly appearing individuals |
| b. | Shared beliefs, behaviors, and expectations of groups |
| c. | Group beliefs about what is right and wrong |
| d. | Groups that come from the same part of the world |
ANS: B
A culture is a set of shared and learned beliefs, behaviors, and expectations among a group of people. The individuals in different cultures may or may not look similar. Group beliefs about what is right or wrong are known as values. Cultural members may come from many different parts of the world.
DIF: Remembering (Knowledge) REF: Page 87 OBJ: 5-3
TOP: Teaching-Learning MSC: Psychosocial Integrity
14.A student nurse expresses frustration to the faculty member regarding an ethnic older adult who appears to be noncompliant. The student states, “Why can’t the patient just do what we teach her to do?” What response by the nurse is best?
| a. | “Yes, I realize how frustrating this must be for you.” |
| b. | “People from her culture are never compliant.” |
| c. | “Maybe you can find a different way to get through.” |
| d. | “Culture dictates how people respond to others.” |
ANS: D
Culture is a blueprint for responding to individuals, family, and the community. Persons from strong cultural backgrounds cannot just change their behavior when instructed to do so. The nurse explains this to the student. Stating that the nurse understands the frustration is helpful but does not give the student any information that could help him or her work with this patient. Stating that people from a certain culture are never compliant is biased and prejudicial. “Getting through” to the patient implies ethnocentrism and bias.
DIF: Applying (Application) REF: N/A OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
15.A patient from a culture that differs from that of the nurse is hospitalized and near death. What action by the nurse best demonstrates cultural care preservation?
| a. | Allowing the family to remain at the bedside |
| b. | Pinning a healing amulet to the patient’s gown |
| c. | Offering the family food and drink in the room |
| d. | Giving the family time to be alone with the patient |
ANS: B
Cultural care preservation refers to those assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and maintain their well-being, to recover from illness, or to face handicaps or death. Allowing the patient to have healing artifacts important in his or her culture nearby best demonstrates this concept. The other actions are caring but do not demonstrate this principle.
DIF: Applying (Application) REF: N/A OBJ: 5-9
TOP: Caring MSC: Psychosocial Integrity
16.The nurse uses the LEARN model when providing care. What event best demonstrates that this model has been successful?
| a. | The nurse learns about the patient’s culture and how it impacts care. |
| b. | The patient and nurse agree on a mutually acceptable plan of action. |
| c. | The nurse listens carefully to the patient’s concerns and beliefs. |
| d. | The patient understands how medical care will be beneficial. |
ANS: B
The LEARN model includes listening to the patient, explaining your own perspectives, acknowledging the similarities and differences in both viewpoints, recommending a plan of action, and negotiating a final plan. If the patient and nurse have come to an agreement on a plan of action, this model has been successful.
DIF: Evaluating (Evaluation) REF: N/A OBJ: 5-7
TOP: Caring MSC: Psychosocial Integrity
17.A new nurse is caring for a patient from Appalachia. The patient seems guarded and secretive, which frustrates the new nurse. What advice from the mentor is most appropriate?
| a. | “Maybe you should ask to change your assignment.” |
| b. | “This is a normal behavior for this patient’s cultural group.” |
| c. | “You could try to apologize for anything you may have done.” |
| d. | “Ask the patient why she is acting so strangely around you.” |
ANS: B
Patients from the Appalachian culture are typically wary and guarded around strangers and view the hospital as a place to go and die. The nurse explains this to the new nurse. Changing assignments will not help the new nurse become culturally competent. The new nurse could ask the patient if there has been some offense, but this is probably not the case. “Why” questions put people on the defensive and are not considered examples of therapeutic communication.
DIF: Understanding (Comprehension) REF: Page 87 OBJ: 5-6
TOP: Caring MSC: Psychosocial Integrity
18.A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best?
| a. | Limit the number of visitors the patient can have. |
| b. | Only allow family members to visit the patient. |
| c. | Suggest shorter visits to the patient’s visitors. |
| d. | Require visitors to check in at the front desk. |
ANS: C
In Arab American Muslim culture, visiting the sick is a cultural value and expectation. Although the visits may be tiring, they may also be important to the patient. The nurse can suggest shorter visits so the patient can have both the visitors and more rest. Limiting the number of visitors would violate this cultural norm as would limiting visits to family only. Checking in at the front desk serves no useful purpose.
DIF: Applying (Application) REF: N/A OBJ: 5-6
TOP: Caring MSC: Psychosocial Integrity
19.A director of nursing works in a hospital that serves many Jehovah’s Witness patients. What action by the nurse would best facilitate culturally appropriate health care?
| a. | Establish a bloodless surgery program. |
| b. | Create an immunization clinic for children. |
| c. | Employ spiritual leaders from this faith. |
| d. | Allow faith healing ceremonies. |
ANS: A
Jehovah’s Witnesses generally are opposed to receiving all blood products. A bloodless surgery program would be a culturally competent way to improve the health care of this population.
DIF: Applying (Application) REF: N/A OBJ: 5-5
TOP: Caring MSC: Psychosocial Integrity
20.An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patient’s children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate?
| a. | Allow the family to pray with the patient then escort them to the waiting room. |
| b. | Call security to keep the family from interfering with medical care. |
| c. | Check facility policies and contact the hospital social worker. |
| d. | Call the police who can force the family to accept medical care. |
ANS: C
This family may be Christian Scientists, who do not believe in medical care. Health crises are thought to be errors of the mind that can be altered by prayer. The nurse should check the facility policies for treating vulnerable adults and possibly notify social work, who can assist with ensuring adequate treatment occurs as allowed by policy. Allowing the family to pray with the patient is a caring action, but this complex situation requires more intervention. Calling security or the police will antagonize the family even more and demonstrates an adversarial relationship.
DIF: Applying (Application) REF: N/A OBJ: 5-6
TOP:Communication and Documentation
MSC: Safe Effective Care Environment
MULTIPLE RESPONSE
1.When attempting to reflect about personal cultural awareness, the nurse asks himself or herself which of the following quetions? (Select all that apply.)
| a. | What image do I want to project to members of other cultures? |
| b. | What makes a culture worthy of biased treatment? |
| c. | Have my life experiences contributed to any biases regarding other cultures? |
| d. | Am I uncomfortable when interacting with members of other cultures? |
| e. | Does the patient’s culture rely on solid science to direct health care? |
ANS: A, C, D
Self-reflection implies thinking that regards how “I,” the individual, perceives/believes/behaves. Awareness of one’s thoughts and feelings about others who are culturally different from oneself is necessary to become culturally aware. No culture is “worthy” of biased treatment. “Solid” science is an ethnocentric principle.
DIF: Applying (Application) REF: N/A OBJ: 5-4
TOP: Caring MSC: Psychosocial Integrity
2.What does the nurse working with older adults from many different cultures know about the demographics of culture in the United States? (Select all that apply.)
| a. | Hispanics will become the largest minority group by 2030. |
| b. | Many persons of color are not counted in the census. |
| c. | The percentage of Native Americans/Native Alaskans will decrease. |
| d. | The number of refugees and immigrants is expected to decrease. |
| e. | Some Native Americans want to identify as specific tribal members. |
ANS: A, B, C
Hispanics are expected to be the largest minority group in the United States by 2030. Many persons of color are not represented in the census, and this underestimates their presence. The percentage of Native Alaskans and Native Americans will rise, as will the number of immigrants/refugees. Some Native Americans may not view themselves as part of this larger group, preferring to identify as a member of a specific tribe.
DIF: Remembering (Knowledge) REF: Page 83 OBJ: 5-1
TOP: Communication and Documentation MSC: Psychosocial Integrity
3.A nurse working in the emergency department is seeing an older patient who does not speak English well. The nurse calls for an interpreter. The student wants to know why the patient’s minor child, who speaks English, cannot interpret. What response by the nurse is best? (Select all that apply.)
| a. | The child may not accurately translate. |
| b. | The child and older adult may be embarrassed. |
| c. | The patient has the right to interpretation. |
| d. | Having a child interpret takes too much time. |
| e. | Privacy laws prohibit this practice. |
ANS: A, B, C
Although in a true emergency the nurse may have to use a child interpreter, this practice is not recommended. The child may not have the vocabulary to translate, the child may “edit” the comments, the child or older adult may be embarrassed by the medical condition, and patients have a legal right to professional interpretation. Using an interpreter always takes more time and privacy laws do not prohibit this practice.
DIF: Understanding (Comprehension) REF: Page 93 OBJ: 5-8
TOP: Communication and Documentation MSC: Psychosocial Integrity
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