Psychiatric Mental Health Nursing From Suffering to Hope 1st Edition By Mertie – Test Bank

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Psychiatric Mental Health Nursing (Potter)

Chapter 5   Sociocultural Awareness

1) A novice nurse is working in a community health center that serves a diverse client population. The nurse says, “The first thing I need to do is learn everything possible about the cultures of all the clients.” What is the best response that the experienced nurse can give the novice nurse?

1. “You should always be nonjudgmental.”

2. “You need to first understand who you are.”

3. “I will give you a great book that describes all of the critical factors.”

4. “This will come with time as you get to know clients and then encounter problems.”

Answer:  2

Explanation:  2. It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the particular cultural groups of interest. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: VIII.6. Reflect on one’s own beliefs and values as they relate to professional practice | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Explain common terminology used when discussing the role of culture in providing psychiatric nursing care.

MNL LO:  1.4.3. Apply nursing strategies that will facilitate communication with individuals of all age groups.

2) The nurse who is advocating for culturally diverse patient issues knows that cultural competence and sensitivity are based primarily on what information?

1. Life experiences

2. Patient assessment

3. Uniformity training

4. Population diversity

Answer:  4

Explanation:  4. Nurses need to make a conscious decision to acknowledge and value the diversity in others. Developing cultural competence and sensitivity needed for comprehensive care is based on new knowledge, personal self-assessment, supervised practice, mentoring experiences, experience in culturally diverse clinical practice settings, participation in discussions, and diversity training. Uniformity training, life experiences, and patient assessments are not the principle factors that make up cultural competence and sensitivity. While it is vital for the nurse to display cultural competence and sensitivity while performing a patient assessment, cultural competence is not based primarily on patient assessment.

Page Ref: 87

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: VIII.6. Reflect on one’s own beliefs and values as they relate to professional practice | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Explain common terminology used when discussing the role of culture in providing psychiatric nursing care.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

3) A nurse is caring for a patient who has undergone an open abdominal surgery. The nurse notes that the patient will only drink warm liquids. The patient tells the nurse, “The cold liquids will make my condition worse.” What response by the nurse best demonstrates cultural humility?

1. “The cold liquids will not make your condition worse.”

2. “The warm liquids will not make your condition better.”

3. “Can you tell me why the cold liquids will make your condition worse?”

4. “Can you tell me why you do not follow the health provider’s suggestion?”

Answer:  3

Explanation:  3. Cultural humility occurs when the nurse recognizes the limitations of his or her own culture and is motivated to learn about other cultures. Asking the patient to explain why the patient will only drink warm liquids and avoids cold liquid, demonstrates that the nurse is motivated to learn about the patient’s culture. The nurse should not tell the patient that cold liquids will not make the patient’s condition worse or that the warm liquids will not make the patient’s condition better, as these are assumptions and not based on fact. The nurse will not suggest that the patient is not following the health care provider’s suggestion.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: VIII.6. Reflect on one’s own beliefs and values as they relate to professional practice | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Explain common terminology used when discussing the role of culture in providing psychiatric nursing care.

MNL LO:  1.4.3. Apply nursing strategies that will facilitate communication with individuals of all age groups.

4) A nurse manager is teaching a group of staff nurses about common terminology used when discussing the role of culture in providing psychiatric nursing care. Which statement made by the nurse manager correctly differentiates race from ethnicity?

1. “Race is determined by the color of the individual’s skin, while ethnicity is genetically determined.”

2. “Race is determined by genetics and characteristics based on geography, while ethnicity includes race.”

3. “Race is determined by common characteristics, while ethnicity is based on geographical characteristics.”

4. “Race is determined by cultural heritage, while ethnicity is determined by the color of the individual’s skin.”

Answer:  2

Explanation:  2. Because culture involves race and ethnicity, it is important to distinguish between these concepts. Race is based on genetically determined and geographically based characteristics. Often, but not always, it is apparent through skin color, which is a biological adaptation to the geography that may vary as groups of people migrate and intergenerate. Ethnicity includes race in that it describes how a group of people share common characteristics, such as nationality, religion, language, and cultural heritage.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: VIII.6. Reflect on one’s own beliefs and values as they relate to professional practice | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome:  Explain common terminology used when discussing the role of culture in providing psychiatric nursing care.

MNL LO:  1.4.3. Apply nursing strategies that will facilitate communication with individuals of all age groups.

5) According to the Giger and Davidhizar’s transcultural assessment model, which nursing action demonstrates the element of social organization?

1. Assessing the patient’s self-control

2. Reviewing the patient’s genetic history and alterations in genetic makeup

3. Assessing the patient’s family and what roles members assume in relation to each other

4. Determining what the patient conveys with both speech and nonverbal communication

Answer:  3

Explanation:  3. Giger and Davidhizar’s transcultural model specifies six dimensions of culture that are essential in nursing assessment, with an underlying assumption that every patient is culturally unique. The element of social organization is best exemplified by assessing the patient’s family and what roles members assume in relation to each other. Assessing the patient’s self-control is an example of the environmental context aspect of this model. Reviewing the patient’s genetic history and alterations in genetic makeup best exemplifies the biological variations aspect of this model. Determining what the patient conveys with both speech and nonverbal communication best exemplifies the communication aspect of this model.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Compare theoretical frameworks that can assist nurses in providing culturally competent care.

MNL LO:  1.2.3. Distinguish among the different psychosocial theories about the development of mental illness.

6) A nurse is caring for a patient who is from a different culture than the nurse. According to Campinha-Bacote, what is the nurse’s first action when providing culturally aware care to the patient?

1. Self-reflection

2. Self-promotion

3. Self-recognition

4. Self-introduction

Answer:  1

Explanation:  1. According to Campinha-Bacote, cultural awareness begins with the nurse’s self-reflection and continual reflection on his or her own roots, biases, and prejudice. Self-introduction, self-recognition, and self-promotion are not aspects of culturally aware care.

Page Ref: 90

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Compare theoretical frameworks that can assist nurses in providing culturally competent care.

MNL LO:  1.2.3. Distinguish among the different psychosocial theories about the development of mental illness.

7) A nurse is caring for a patient from a different culture than the nurse. The patient complains of abdominal pain due to an acute exacerbation of ulcerative colitis. The nurse asks the patient, “What treatment do you think would be helpful, and what do you hope you will gain from the treatment?” What conceptual framework or theory is the nurse demonstrating?

1. Leininger’s sunrise enabler model

2. Leininger’s transcultural nursing theory 

3. Campinha-Bacote’s conceptual framework

4. Giger and Davidhizar’s transcultural assessment model

Answer:  3

Explanation:  3. Campinha-Bacote emphasizes that cultural competence is a process rather than an endpoint and requires five elements: awareness, knowledge, skill, encounters, and desire. Asking the patient what kind of treatment he or she thinks would be helpful and what the patient hopes to experience from treatment utilizes Campinha-Bacote’s idea of cultural awareness. Leininger’s sunrise enabler model depicts the interrelationships among world view; the dimensions of cultural and social structures; and the influences on care expressions, patterns and practices, and holistic health/illness/death within the contexts of folk care, nursing care, and general professional care. Leininger’s transcultural nursing theory defines a caring practice as one that helps individuals achieve health. Giger and Davidhizar’s transcultural assessment model specifies six dimensions of culture that are essential in nursing assessment, with an underlying assumption that every patient is culturally unique. 

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Compare theoretical frameworks that can assist nurses in providing culturally competent care.

MNL LO:  1.2.3. Distinguish among the different psychosocial theories about the development of mental illness.

8) The nurse manager is teaching a group of staff nurses about the various theoretical frameworks that can assist nurses in providing culturally competent care. Which concept of the Giger and Davidhizar’s transcultural assessment model will the nurse manager include in the teaching? Select all that apply.

1. Analysis of genetic and ethnic variations

2. Assessment of both the nuclear and extended family

3. Assessment of the ways the patient performs self-care

4. Assessment of the influence of environment on self-control

5. Encourage the patient to freely offer what might improve the patient’s health

Answer:  1, 2, 4

Explanation:  1. Giger and Davidhizar’s transcultural assessment model specifies six dimensions of culture that are essential in nursing assessment, with an underlying assumption that every patient is culturally unique. Assessment of genetic and ethnic variations describes the biological variations component of the Giger and Davidhizar’s transcultural assessment model. Assessment of both the nuclear and extended family describes the social organization component of the model. Assessment of the influence of environment on self-control describes the environmental context component of the model. Assessment of the ways the patient performs self-care and encouraging the patient to freely offer what might improve the patient’s health both exemplify Leininger’s sunrise enabler model, not the Giger and Davidhizar’s transcultural assessment model. 

2. Giger and Davidhizar’s transcultural assessment model specifies six dimensions of culture that are essential in nursing assessment, with an underlying assumption that every patient is culturally unique. Assessment of genetic and ethnic variations describes the biological variations component of the Giger and Davidhizar’s transcultural assessment model. Assessment of both the nuclear and extended family describes the social organization component of the model. Assessment of the influence of environment on self-control describes the environmental context component of the model. Assessment of the ways the patient performs self-care and encouraging the patient to freely offer what might improve the patient’s health both exemplify Leininger’s sunrise enabler model, not the Giger and Davidhizar’s transcultural assessment model. 

4. Giger and Davidhizar’s transcultural assessment model specifies six dimensions of culture that are essential in nursing assessment, with an underlying assumption that every patient is culturally unique. Assessment of genetic and ethnic variations describes the biological variations component of the Giger and Davidhizar’s transcultural assessment model. Assessment of both the nuclear and extended family describes the social organization component of the model. Assessment of the influence of environment on self-control describes the environmental context component of the model. Assessment of the ways the patient performs self-care and encouraging the patient to freely offer what might improve the patient’s health both exemplify Leininger’s sunrise enabler model, not the Giger and Davidhizar’s transcultural assessment model. 

Page Ref: 88-89

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome:  Compare theoretical frameworks that can assist nurses in providing culturally competent care.

MNL LO:  1.2.3. Distinguish among the different psychosocial theories about the development of mental illness.

9) What concept should guide the nurse’s practice regarding the influence of cultural values on a patient’s health beliefs?

1. Cultural values may shape the status of the patient’s chronic conditions.

2. Cultural values and other differences will negatively influence outcomes.

3. Cultural values may shape perceptions of health, disease, prevention, and treatment.

4. Cultural values will not shape perceptions of health, disease, prevention, and treatment.

Answer:  3

Explanation:  3. The nurse must be aware that cultural values may shape patients’ perceptions of health, disease, prevention, and treatment. While cultural values may reflect the way a patient treats his or her chronic condition, the status of the chronic condition is not influenced by cultural values. If nursing care is delivered with an acknowledgment of cultural differences, then outcomes will be enhanced.

Page Ref: 94

Cognitive Level:  Understanding

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.2. Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome:  Contrast variations in culture that may affect how individuals view and approach health care.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

10) The nurse is caring for a patient from a different cultural background who is having difficulty expressing beliefs about the treatment plan to the physician. What nursing action would be most appropriate for this patient?

1. The nurse should encourage the patient to accept the plan of care as ordered.

2. The nurse should encourage the patient to speak up when the physician is present.

3. The nurse should encourage collaboration between the patient and the physician.

4. The nurse should encourage the patient to discuss concerns with the patient’s spouse so that the spouse can tell the physician.

Answer:  3

Explanation:  3. A conflict may arise when there are differences in values, beliefs, or behaviors between a patient and provider concerning the appropriateness and feasibility of a treatment plan. The nurse should encourage collaboration between the patient and the physician. Encouraging the patient to speak up, accept the plan of care, or have a spouse act on the patient’s behalf are strategies that do not address the patient’s needs.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.2. Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Relationship Centered Care: The role of family, culture, and community in a person’s development | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Contrast variations in culture that may affect how individuals view and approach health care.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

11) The staff nurse overhears a group of novice nurses speaking about current events. One novice nurse states, “All of these school shootings should be proof that mentally ill patients cause all these violent acts.” What is the staff nurse’s best response?

1. “Patients with mental illness do need more attention to help prevent them from committing violence.”

2. “Patients with mental illness do need more attention, and all the recent violence in schools provides proof of that.”

3. “As nurses, we need to be aware of any stigma placed on those with mental illness. Those with mental illness do not perpetrate violence.”

4. “As nurses, we need to be aware of any stigma placed on those with mental illness. Those without mental illness are equally likely to commit violence.”

Answer:  4

Explanation:  4. Regardless of the cultural background, mental illness and treatment for mental health issues is fraught with misconceptions and stereotypes, resulting in stigma. The staff nurse who overhears the novice nurse display stigma should intervene by telling the novice nurse that, though those with mental illness may perpetrate violence, individuals without mental illness are equally likely to commit violence. While patients with mental illness need attention, these individuals are not the reason for all violent acts.

Page Ref: 92

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Effective communication | Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome:  Contrast variations in culture that may affect how individuals view and approach health care.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

12) The nurse is caring for patients who present to the emergency department with psychiatric symptoms. What does the nurse know is true regarding the potential effects of stigma on these patients? Select all that apply.

1. These patients are often not taken seriously.

2. These patients may be treated poorly due to scarce resources.

3. These patients may be left for hours untreated in emergency departments.

4. Patients with schizophrenia generally receive appropriate treatment in emergency settings.

5. Patients with schizophrenia may die earlier than those without schizophrenia, due to poor treatment.

Answer:  1, 2, 3, 5

Explanation:  1. Nurses and staff in emergency departments have frequent contact with patients who have psychiatric illnesses. Research indicates that these patients have reported being isolated in the emergency department and left for hours without services or monitoring beyond in-room cameras or occasional visits. Patients with psychiatric illness are often not taken seriously due to the stigma associated with psychiatric illness. Patients with schizophrenia die up to 25 years earlier than those without schizophrenia, due to poor treatment. 

2. Nurses and staff in emergency departments have frequent contact with patients who have psychiatric illnesses. Research indicates that these patients have reported being isolated in the emergency department and left for hours without services or monitoring beyond in-room cameras or occasional visits. Patients with psychiatric illness are often not taken seriously due to the stigma associated with psychiatric illness. Patients with schizophrenia die up to 25 years earlier than those without schizophrenia, due to poor treatment. 

3. Nurses and staff in emergency departments have frequent contact with patients who have psychiatric illnesses. Research indicates that these patients have reported being isolated in the emergency department and left for hours without services or monitoring beyond in-room cameras or occasional visits. Patients with psychiatric illness are often not taken seriously due to the stigma associated with psychiatric illness. Patients with schizophrenia die up to 25 years earlier than those without schizophrenia, due to poor treatment. 

5. Nurses and staff in emergency departments have frequent contact with patients who have psychiatric illnesses. Research indicates that these patients have reported being isolated in the emergency department and left for hours without services or monitoring beyond in-room cameras or occasional visits. Patients with psychiatric illness are often not taken seriously due to the stigma associated with psychiatric illness. Patients with schizophrenia die up to 25 years earlier than those without schizophrenia, due to poor treatment. 

Page Ref: 92

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome:  Contrast variations in culture that may affect how individuals view and approach health care.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

13) A nurse is caring for a patient who is grieving after her spouse died suddenly and unexpectedly from cardiac arrest. The patient tells the nurse that the spouse’s death is due to supernatural forces. What is the nurse’s best response?

1. “Supernatural forces are not the cause of your husband’s death.”

2. “Why do you refuse to admit that the cause of your husband’s death is heart disease?”

3. “Why do you think supernatural forces were the cause of your husband’s death?”

4. “Supernatural forces may be to blame for your husband’s death if you believe they are.” 

Answer:  3

Explanation:  3. Some common health problems are attributed to different cultural beliefs. Among some members of the African American culture, sudden and unexplained death may be seen as being caused by voodoo or supernatural forces. To provide culturally competent care to the patient, the nurse should attempt to clarify the patient’s beliefs or feelings. The nurse will not tell the patient that supernatural forces are either fictional or the cause of the spouse’s death; both of these responses do not allow the patient to describe to the nurse the reasons why the patient feels that supernatural forces are to blame. The nurse should also not ask the patient why she refuses to believe that her spouse died due of heart disease; this response does not validate the patient’s spiritual beliefs.

Page Ref: 93

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Summarize physical and mental health problems commonly seen in different cultures.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

14) The nurse is caring for a Hispanic woman who presented to the emergency department after falling suddenly ill with intense, cramp-like abdominal pains. What cultural statements might the nurse anticipate from the patient regarding the possible cause of the illness? Select all that apply.

1. “My illness is caused by working too hard.”

2. “The cold weather is making me weak and ill.”

3. “My deceased family member has put a curse on me.”

4. “The woman at the bank gave me the evil eye and now I am sick.”

5. “The food I ate must have formed into a ball and is clinging to my stomach.”

Answer:  2, 4, 5

Explanation:  2. Individuals from a Hispanic culture believe in empacho, when food forms into a ball and clings to the stomach, causing pain and cramps. Individuals within the Hispanic culture may also believe in wind/cold illness, or the fear of wind and cold contributing to weakness and susceptibility to illness when the natural elements are imbalanced. Also, individuals with the Hispanic culture may believe in Mal ojo, or the belief that illness is caused by an individual using the “evil eye.” A patient from a Native American or Alaskan American culture is more likely to associate illness or disease with a curse from a deceased family member (called ghost sickness). Karoshi, a term used by individuals of the Asian and Pacific Islander cultures, is death by working too hard.

4. Individuals from a Hispanic culture believe in empacho, when food forms into a ball and clings to the stomach, causing pain and cramps. Individuals within the Hispanic culture may also believe in wind/cold illness, or the fear of wind and cold contributing to weakness and susceptibility to illness when the natural elements are imbalanced. Also, individuals with the Hispanic culture may believe in Mal ojo, or the belief that illness is caused by an individual using the “evil eye.” A patient from a Native American or Alaskan American culture is more likely to associate illness or disease with a curse from a deceased family member (called ghost sickness). Karoshi, a term used by individuals of the Asian and Pacific Islander cultures, is death by working too hard.

5. Individuals from a Hispanic culture believe in empacho, when food forms into a ball and clings to the stomach, causing pain and cramps. Individuals within the Hispanic culture may also believe in wind/cold illness, or the fear of wind and cold contributing to weakness and susceptibility to illness when the natural elements are imbalanced. Also, individuals with the Hispanic culture may believe in Mal ojo, or the belief that illness is caused by an individual using the “evil eye.” A patient from a Native American or Alaskan American culture is more likely to associate illness or disease with a curse from a deceased family member (called ghost sickness). Karoshi, a term used by individuals of the Asian and Pacific Islander cultures, is death by working too hard.

Page Ref: 93

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize physical and mental health problems commonly seen in different cultures.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

15) A nurse is caring for a patient of the Alaskan Native culture who is depressed, angry, and withdrawn after recently being terminated from a high-paying occupation. What mental health problem, seen specifically in the American Indian and Alaskan Native cultures, does the nurse suspect the patient has?

1. Amok

2. Latah

3. Wacinko

4. Windingo

Answer:  3

Explanation:  3. The term Wacinko is used by both the Native American and Native Alaskan cultures. This term pertains to feelings of social withdrawal and anger in response to interpersonal disappoint and rejection. The term Windingo is used by both the Native American and Native Alaskan cultures; however, this term describes an intense urge for cannibalism with disgust for regular food. The term Latah is used by both the Asian and Pacific Islander cultures to describe a startle reaction with defensive behavior. The term Amok is also used by both the Asian and Pacific Islander cultures to describe a sudden outburst of aggression followed by apathy and withdrawal.

Page Ref: 93

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize physical and mental health problems commonly seen in different cultures.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

16) The nurse is caring for a patient from the Pacific Islander culture who presented to the emergency department with symptoms of both depression and an acute cardiac event. What mental health problem, unique to the patient’s culture, does the nurse suspect?

1. Zar

2. Falling out

3. Wincinko

4. Sinking heart

Answer:  4

Explanation:  4. Individuals from the Pacific Islander culture may present with sinking heart, with symptoms of both depression and an acute cardiac event. Falling out is associated with the African American culture and describes a sudden collapse without warning in response to trauma. Zar is a mental health problem associated with the African American culture that describes an altered state of consciousness in which the person is possessed by a spirit. Wincinko is a term used by the American Indian and Alaskan Native populations to indicate feelings of anger, withdrawal, mutism, and suicide in response to interpersonal disappointment.

Page Ref: 93

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.5. Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize physical and mental health problems commonly seen in different cultures.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

17) A nurse is admitting a patient who is from Japan and does not speak English. What is the nurse’s priority action?

1. Call for a Japanese interpreter.

2. Follow the admission assessment paperwork carefully.

3. Talk with the patient to determine the patient’s level of fluency.

4. Ask all family members to stay with the patient during the admission assessment.

Answer:  3

Explanation:  3. The priority is for the nurse to determine the patient’s level of fluency in English and assess the degree to which another language is used as the primary language. If the assessment indicates the need for an interpreter, then the nurse should refer the patient for services. Carefully following the assessment paperwork will not be helpful if the nurse and the patient do not understand each other. It is unprofessional and inappropriate for family members to serve as interpreters.

Page Ref: 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Apply principles of cultural sensitivity when working with patients and staff in mental health settings.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

18) A nurse is asked to consult with the local domestic violence shelter where the shelter employees state that individuals from a particular culture do not use the services offered. An employee states, “I bet that these women are being abused because of the violent nature of that culture.” What recommendation will the nurse suggest?

1. The agency should place flyers in the local schools.

2. The agency should advertise their services in the local newspaper.

3. The agency should add a culturally competent greeting on the agency’s phone message.

4. The agency should promote culturally competent values, policy, structures, and practices.

Answer:  4

Explanation:  4. Agencies that acknowledge, accept, and work with cultural differences may be viewed as “culturally competent,” whereas those agencies that ignore culture when delivering services are viewed as “culturally blind.” There may be an increased risk of conflict in health care services when providers lack cultural sensitivity. Strategies to increase advertising and add a culturally competent phone message should be targeted at the specific cultural group as a part of a larger strategy.

Page Ref: 87, 88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome:  Apply principles of cultural sensitivity when working with patients and staff in mental health settings.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

19) The psychiatric-mental health nurse is caring for a patient who is from a different culture than the nurse. What action best demonstrates the principle of cultural sensitivity?

1. The nurse adheres to his or her own experiences regardless of any past enculturation.

2. The nurse adheres to the patient’s cultural practices regardless of any safety concerns.

3. The nurse attempts to use his or her own culture to guide clinical decisions for the patient.

4. The nurse attempts to understand the patient’s culture in order to guide clinical decisions for the patient.

Answer:  4

Explanation:  4. Cultural sensitivity involves inquiring about the patient’s own culture in order to understand the patient and to help guide clinical decisions. Cultural sensitivity does not involve the nurse adhering to his or her own experiences or own culture, nor does it involve disregarding the patient’s safety.

Page Ref: 95

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Apply principles of cultural sensitivity when working with patients and staff in mental health settings.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

20) A novice nurse who wants to provide culturally competent care will include which elements when caring for patients?

1. Acceptance and guidance

2. Knowledge and sympathy

3. Awareness and sensitivity

4. Understanding and approving

Answer:  3

Explanation:  3. Culturally competent care involves the nurse’s awareness and sensitivity to the patient’s culture. The nurse does not need to accept, guide, approve, or sympathize with the patient’s culture in order to provide culturally competent care. While knowledge and understanding help the nurse in providing holistic care, these elements are not necessary elements to providing culturally competent care.

Page Ref: 95

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Apply principles of cultural sensitivity when working with patients and staff in mental health settings.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

21) What is the primary rationale for the assessment of patients’ personal values?

1. Patients’ values should be congruent with nurses’ values.

2. Health behaviors are strongly influenced by personal values.

3. Personal values regarding health are universal across all cultures.

4. Personal values form the scientific rationale for health behaviors.

Answer:  2

Explanation:  2. Personal values are shaped by culture. Perceptions of health, disease, prevention, and treatment may vary among different cultural groups. Acknowledging divergent values can be a significant first step toward improving one’s cultural competence and sensitivity to differences. Health behaviors are determined by a number of factors. The patient’s values do not have to be congruent with the nurse’s values. Health values vary across cultures.

Page Ref: 89

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Evaluate the impact of societal influences on individual mental health and illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

22) A patient with a history of alcohol dependence is discharged with nutritional recommendations to increase the intake of vitamin B foods and thiamine. What factor does the nurse recognize as most likely to impede the patient’s ability to adhere to the treatment plan?

1. Age

2. Education level

3. Lifestyle habits

4. Social environment

Answer:  3

Explanation:  3. Dietary practices are lifestyle habits that will influence the patient’s ability to adhere to the treatment plan. Education level or social environment may or may not influence patient adherence to the dietary recommendations. Age should not influence the patient’s ability to adhere to the dietary recommendations.

Page Ref: 89-91

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  Evaluate the impact of societal influences on individual mental health and illness.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

23) The nurse is caring for at-risk individuals at a free community health center. What social variables does the nurse recognize as having the potential to increase the patient’s vulnerability to mental illness? Select all that apply.

1. Poverty

2. Unemployment

3. Sexual orientation

4. Underemployment

5. Educational opportunities

Answer:  1, 2, 4, 5

Explanation:  1. Populations that are at greater risk for developing mental illness are considered vulnerable populations. Vulnerability may be determined by various factors, including social variables. Social variables include poverty, unemployment, educational opportunities, and underemployment. Sexual orientation is also considered a variable for vulnerability, but it is not considered a social variable.

2. Populations that are at greater risk for developing mental illness are considered vulnerable populations. Vulnerability may be determined by various factors, including social variables. Social variables include poverty, unemployment, educational opportunities, and underemployment. Sexual orientation is also considered a variable for vulnerability, but it is not considered a social variable.

4. Populations that are at greater risk for developing mental illness are considered vulnerable populations. Vulnerability may be determined by various factors, including social variables. Social variables include poverty, unemployment, educational opportunities, and underemployment. Sexual orientation is also considered a variable for vulnerability, but it is not considered a social variable.

5. Populations that are at greater risk for developing mental illness are considered vulnerable populations. Vulnerability may be determined by various factors, including social variables. Social variables include poverty, unemployment, educational opportunities, and underemployment. Sexual orientation is also considered a variable for vulnerability, but it is not considered a social variable.

Page Ref: 92

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.2. Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Evaluate the impact of societal influences on individual mental health and illness.

MNL LO:  1.3.3. Explore the effect of culture on the treatment of mental health disorders.

24) A nurse is caring for a patient with a major psychiatric illness. That patient comes from a different culture than the nurse. What is the nurse’s best rationale for using the Cultural Formulation Interview (CFI) when assessing this patient?

1. It is used to inquire about the patient’s health care practices based on the patient’s culture and to identify areas of improvement.

2. It is used to guide the nurse to self-reflect his or her own judgments regarding the patient’s culture and current mental illness.

3. It is used to elicit the patient’s cultural understanding of the mental illness and to clarify the role of social and cultural influences.

4. It is used to guide the nurse to appropriate interventions based on the patient’s cultural practices and to clarify the nurse’s understanding about the patient’s culture.

Answer:  3

Explanation:  3. The Cultural Formulation Interview (CFI) may be used by any clinician, including the nurse, to elicit the patient’s cultural understanding of the mental illness and to clarify the role of social and cultural influences on the patient’s health status. This tool is used to gain information from and about the patient, not to guide the nurse to self-reflect or to appropriately choose interventions. This tool does not help to identify areas of improvement to the patient’s current heath care practices.

Page Ref: 94

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.2. Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Quality and Safety: Tools for effective and open communication | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Evaluate the impact of societal influences on individual mental health and illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

25) When assessing a patient from a different culture, what is the most effective approach to meet the goal of cultural sensitivity?

1. Teach the patient how to assimilate into the dominant culture.

2. Explain to the patient that values must be adjusted to reach a healthy state.

3. Determine what aspects of the patient’s life should be preserved as they are.

4. Ask the patient how he or she is alienated from his or her primary cultural group.

Answer:  3

Explanation:  3. Cultural sensitivity is the process of increasing professional effectiveness through understanding, respecting, and appreciating the importance of cultural factors in the delivery of health services. Asking the patient how he or she is alienated, teaching the client to assimilate, and explaining that the patient’s values have to be changed are neither sensitive nor supportive.

Page Ref: 87-88

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  Plan culturally sensitive nursing care for patients with mental illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

26) What nurse is exhibiting cultural sensitivity?

1. The nurse who learns a second language.

2. The nurse who develops a patient activity group.

3. The nurse who develops a patient educational group.

4. The nurse who is comfortable allowing the patient to pray only once during the day.

Answer:  1

Explanation:  1. The nurse who is learning a second language is working at increasing his or her awareness and openness to other cultures. The nurse who is only comfortable letting the patient pray once per day is exhibiting cultural blindness. The nurses who develop the activity group and the educational group are providing care that can be generalized to all patients and are not necessarily exhibiting cultural sensitivity.

Page Ref: 87-88

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Plan culturally sensitive nursing care for patients with mental illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

27) After providing safety for a patient with suicidal ideations, the nurse wishes to determine the patient’s starting point of treatment as well as the patient’s commitment for change. Which tool will best determine this information?

1. Cultural Formulation Interview (CFI)

2. WHO Disability Assessment Schedule (WHODAS)

3. Culturally and Linguistically Appropriate Services (CLAS)

4. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Answer:  2

Explanation:  2. The WHO Disability Assessment Schedule (WHODAS) is a 36-item self-report that can be used to determine the patient’s starting point of treatment as well as the patient’s commitment for change. The Culturally and Linguistically Appropriate Services (CLAS) is the standard that requires that all patients be given the right to treatment appropriate to their own cultural standards. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published by the American Psychiatric Association and is a reference for mental health clinician that, lists and explains all mental illnesses. The Cultural Formulation Interview (CFI) is a tool used to elicit a patient’s cultural understanding of a mental health issue and to clarify the role of social and cultural influences on the patient’s health status.

Page Ref: 94

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Quality and Safety: Tools for effective and open communication | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Plan culturally sensitive nursing care for patients with mental illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

28) The nurse is caring for a patient of the Hispanic culture who tells the nurse, “The reason I’m hearing voices in my head is because my neighbor gave me the evil eye and cursed me.” When planning appropriate nursing interventions for the patient, what is the nurse’s best understanding of the patient’s statement?

1. The patient is describing a cultural myth.

2. The patient is describing a culture-bound syndrome.

3. The patient is experiencing delusions.

4. The patient’s culture uses folklore elements to explain medical conditions.

Answer:  2

Explanation:  2. The Hispanic culture may use the term Mal Ojo to describe illness that occurs after another person gives the patient the “evil eye.” This description is a culture-bound syndrome. While culture-bound syndromes exist, it is important for the nurse to understand that these syndromes may also be the source of cultural discrimination. The patient may have delusions; however, this is not evident in the question. The patient does not believe the “evil eye” is folklore or myth.

Page Ref: 93

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Relationship Centered Care: Affirm and value diversity | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Plan culturally sensitive nursing care for patients with mental illness.

MNL LO:  1.5.4. Examine the nurse’s role in each of the different types of mental health interventions.

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