Link download full: Test bank for Population and Community Health Nursing 6th Edition by Clark Download

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1 Link download full: Test bank for Population and Community Health Nursing 6th Edition by Clark Download Sample Population and Community Health Nursing, 6e (Clark) Chapter 5 Cultural Influences on Population Health 1) The nurse is taking a class to become more culturally competent when providing care. In this class the nurse learns that the American work ethic is considered to be one that is hardworking and individualistic. The nurse should categorize the work ethic as being a part of: 1. Culture. 2. Ethnicity. 3. Nationality. 4. Acculturation. Answer: 1 Explanation: 1. Culture is a universal experience and can transcend ethnic lines. Ethnicity can be part of culture. In culture, people act in prescribed behavior patterns, though the patterns may have variations from group to group. The American work ethic is considered a cultural characteristic of its citizens. Nationality is the country of birth. Ethnicity is an aggregate of cultural practices and social influences that shape a community s distinct identity. Acculturation is the process of becoming cultured into a group. Nursing/Int.Conc: Nursing Process: Assessment

2 Cognitive Level: Analysis Learning Outcome: 5-1 2) Nursing students from various backgrounds enroll in a university s nursing curriculum. The process by which they become nurses includes aspects of: 1. Culture. 2. Ethnicity. 3. Worldview. 4. Acculturation. Answer: 4 Explanation: 4. Acculturation is cultural assimilation, where there is acquisition of some beliefs, values, and behaviors of another culture, in this case, nursing. While the students ultimately become part of the nursing culture, they have to be assimilated or undergo acculturation to become part of that culture. Ethnicity is an aggregate of cultural practices, social influences, and racial characteristics which is not a part of entering the nursing culture. Worldview refers to how a cultural group views the universe and their relationship to it. Nursing/Int.Conc: Nursing Process: Implementation Learning Outcome: 5-1 3) During a health history a patient states he is Asian American. What should the nurse realize this patient is describing? 1. Race. 2. Culture. 3. Ethnicity. 4. Nationality. Answer: 3

3 Explanation: 3. Referring to oneself by placing the cultural group before the word American explains the patient s ethnicity, which is an aggregate of cultural practices, social influences, and racial characteristics that shape a distinct identity. Many Americans of different national origins celebrate and practice customs that originated in their ancestors countries of birth. Nationality is the country of birth. Race is an artificial categorization based on genetic inheritance and appearance. Culture is the sum of the ways of thinking and acting within a group that defines the group. Ethnicity can be present in culture. Nursing/Int.Conc: Nursing Process: Assessment Learning Outcome: 5-1 4) The population health nurse notes that the African American population of the United States has a higher incidence of cardiovascular disease and diabetes. What aspect of this population s diet should the nurse relate to these health problems? 1. High in fat and sugars. 2. Low in processed foods and fat. 3. Low in fiber-rich foods and exercise. 4. High in starchy vegetables and sugars. Answer: 1 Explanation: 1. The traditional African American diet that relies on foods high in fat and sugars is connected to the high rates of cardiovascular disease and diabetes in the United States. It also has historical roots in foods that were affordable on very limited incomes, which tended to be the fattier meats and foods with sugar. A diet low in processed food and fats helps to eliminate these risk factors. Fiber rich foods in addition to exercise contribute to cardiovascular and diabetes prevention. While starchy vegetables and sugars can contribute to diabetes, the fat content is a determinant in cardiovascular disease. Nursing/Int.Conc: Nursing Process: Evaluation

4 Client Need: Health Promotion and Maintenance Learning Outcome: 5-2 5) While providing health teaching to an older patient of Asian descent the nurse notes that the patient agrees to all questions the nurse asks. What method should the nurse use to determine that the patient understands health teaching? 1. Use simple language that the person can understand. 2. Have another member of the person s family do the teaching. 3. Ensure that there is an interpreter nearby while doing the health teaching. 4. Ask the person to give an explanation, in their own words, of the health teaching. Answer: 4 Explanation: 4. There is a great respect for authority among older people of Asian background. As such, they tend to agree with what is being said or done rather than question it, even if only for clarity of understanding. It would be considered disrespectful to question authority. The nurse could elicit understanding of the person by asking them to explain what was taught essentially a return demonstration. There is no indication that the person does not understand English, therefore an interpreter may not be necessary. A family member might wish to be present, but it is not necessary to the success of the health teaching. Using simple language is not the most reliable method to determine if the person understands health teaching; it would be best to elicit understanding of the person by asking them to explain what was taught. Nursing/Int.Conc: Nursing Process: Evaluation Learning Outcome: 5-2

5 6) During a home visit the nurse notes that a patient originally from Mexico seems passive during health teaching and follow-up questions about the home treatment plan. What should the nurse conclude about this patient s behavior? 1. The patient probably does not understand English. 2. The patient is not interested in what the nurse is doing. 3. There may be cultural factors that explain the patient s behavior. 4. The patient may be uncomfortable with having the nurse in the home. Answer: 3 Explanation: 3. Cultural background may influence how the patient responds to questions and teaching. In Mexican culture, it is expected that the nurse, as the authority figure, will take care of all the patient s needs. The nurse may perceive this as disinterest. The patient assumes a dependent position in health care. There is no indication that the patient is not fluent in English, or that there is discomfort in having the nurse perform a home visit. Nursing/Int.Conc: Nursing Process: Assessment Cognitive Level: Analysis Learning Outcome: 5-2 7) The nurse desires to improve cultural competence when providing patient care. What action should the nurse take first to develop this competency? 1. Understand the culture of the patient. 2. Identify the goals for culturally competent care. 3. Gain proficiency in another language beyond English. 4. Understand and recognize the nurse s own cultural background. Answer: 4 Explanation: 4. Until the nurse can understand and acknowledge the cultural background from which the nurse operates, it will be very difficult to develop cultural competence. Gaining proficiency in another language and understanding the patient s culture is important to developing cultural

6 competence as well as understanding the goals of culturally competent care, but less important than the nurse understanding and recognizing his or her own cultural background. Nursing/Int.Conc: Nursing Process: Implementation Learning Outcome: 5-3 8) The population health nurse is planning to develop cultural competence within a community. Which actions should the nurse take? (Select all that apply.) 1. Ensuring that all patients are treated in the same manner. 2. Recognizing subgroup differences within cultural groups. 3. Ensuring that health clinics employ minority staff to deliver care. 4. Engaging in community partnerships to help design culturally relevant services. 5. Maintaining an up-to-date demographic, cultural, and epidemiologic community profile. Answer: 2, 4, 5 Explanation: 2. Maintaining an up-to-date community demographic profile and engaging in partnerships to help design relevant services are two measures to help develop culturally competent care. Employing minority staff and treating all patients the same way does not indicate cultural competence and could actually be offensive to the patients. It is important to recognize that differences within subgroups of a particular culture may exist. 4. Maintaining an up-to-date community demographic profile and engaging in partnerships to help design relevant services are two measures to help develop culturally competent care. Employing minority staff and treating all patients the same way does not indicate cultural competence and could actually be offensive to the patients. It is important to recognize that differences within subgroups of a particular culture may exist.

7 5. Maintaining an up-to-date community demographic profile and engaging in partnerships to help design relevant services are two measures to help develop culturally competent care. Employing minority staff and treating all patients the same way does not indicate cultural competence and could actually be offensive to the patients. It is important to recognize that differences within subgroups of a particular culture may exist. Nursing/Int.Conc: Nursing Process: Implementation Learning Outcome: 5-5 9) A community has had an influx of immigrant workers due to new construction of businesses in the community. The staff of the local public health clinic know the level of their care meets and exceeds standards set and do not see a need to change. Which behavior is this staff displaying? 1. Cultural blindness. 2. Cultural proficiency. 3. Cultural competence. 4. Cultural destructiveness. Answer: 1 Explanation: 1. Treating everyone alike and ignoring cultural differences such as this example, with an influx of an immigrant population, is cultural blindness. Cultural destructiveness happens when the dominant culture in the organization believes other cultures are inferior. Cultural proficiency occurs when the organization is proactive with diversity and seeks to incorporate it. Cultural competence is the result of the products of developing culturally sensitive care. Nursing/Int.Conc: Nursing Process: Assessment Cognitive Level: Analysis Learning Outcome: 5-4

8 10) The local clinic employs a Hispanic receptionist, who is also used as an interpreter for the many non-english-speaking Latino patients who utilize the clinic. Members of the staff believe the patients should learn English, and they have refused offers from the receptionist to learn some basic phrases. Which behavior is the staff demonstrating about culturally competent care? 1. Cultural blindness. 2. Cultural incapacity. 3. Cultural destructiveness. 4. Cultural precompetence. Answer: 2 Explanation: 2. A token minority staff is employed to aid patients who cannot speak English and the staff feels no need to change. This is cultural incapacity. Cultural destructiveness occurs when organization members believe others are inferior to the dominant culture and no attempt is made to promote cultural diversity in the workforce. Cultural blindness fails to recognize the differences among cultures and the influence of culture on health and health care. Cultural precompetence has the organization planning to be culturally competent but displays complacence based on minimal effort toward that goal. Nursing/Int.Conc: Nursing Process: Assessment Cognitive Level: Analysis Learning Outcome: ) A local hospital has established outreach clinics in the community to provide health care. Several staff members within the clinic component refuse to go to some of the outreach clinics claiming that the clinics are in a bad section of the community and the residents there are not interested in health promotion. Which behavior is the staff demonstrating? 1. Cultural blindness. 2. Cultural incapacity.

9 3. Cultural destructiveness. 4. Cultural precompetence. Answer: 3 Explanation: 3. Cultural destructiveness occurs when members of the organization lack cultural knowledge. Linking an area of a community with a preconceived idea of its residents contributes to cultural destructiveness. Cultural incapacity occurs when there is token minority representation with no attempt to engage in any cross-cultural training. Cultural blindness is where the organization treats everyone the same way. Cultural precompetence is where the organization makes plans for cultural competence but is complacent about its efforts toward it. Nursing/Int.Conc: Nursing Process: Assessment Cognitive Level: Analysis Learning Outcome: ) The nurse is preparing to complete a cultural assessment of a group. Which components should the nurse include in this assessment? (Select all that apply.) 1. Ask personal questions about the group. 2. Look for similarities in one s own group. 3. Talk and interview members of the group. 4. Come prepared with prior research done on the group. 5. Acknowledge the group s reliance on alternative therapies. Answer: 2, 3 Explanation: 2. Talking with members of the group can provide insights into the group s culture. Looking for similarities in the group with one s own group can help the nurse understand the group culture. While doing prior research on a group is acceptable, it could also cause the nurse to have preconceived ideas. Asking personal questions may be resented by group members, so this should be ascertained before asking such questions. Acknowledging the

10 group s reliance on alternative therapies implies stereotyping a group and is not part of a cultural assessment process. 3. Talking with members of the group can provide insights into the group s culture. Looking for similarities in the group with one s own group can help the nurse understand the group culture. While doing prior research on a group is acceptable, it could also cause the nurse to have preconceived ideas. Asking personal questions may be resented by group members, so this should be ascertained before asking such questions. Acknowledging the group s reliance on alternative therapies implies stereotyping a group and is not part of a cultural assessment process. Nursing/Int.Conc: Nursing Process: Assessment Learning Outcome: ) A patient sees a physician for health needs as well as a practitioner of Chinese medicine. Which standards should the nurse identify are being met by the practitioner of Chinese medicine to ensure for the patient s safety? (Select all that apply.) 1. Causing no additional stress on the patient. 2. Nationwide certification in Chinese medicine. 3. USDA standards in the herbal preparations used. 4. Safety, efficacy, and quality in the Chinese medicine practice. 5. No adverse interactions between herbal preparations used and any prescription medications the patient might be on. Answer: 1, 4, 5 Explanation: 1. The patient is utilizing complementary alternative therapy (CAT) with the combination of Western and Chinese medicine. The World Health Organization (WHO) has identified safety, efficacy, and quality as a consideration for CAT. CAT should put no additional stress on the patient, nor should the Chinese herbal preparations used have any adverse interaction with any prescribed medication. While the USDA has some regulatory control

11 with herbal preparations, it cannot set standards for their usage, because herbal preparations are considered supplements and not medication. Nationwide certification in Chinese medicine is not required for the practice of Chinese medicine. 4. The patient is utilizing complementary alternative therapy (CAT) with the combination of Western and Chinese medicine. The World Health Organization (WHO) has identified safety, efficacy, and quality as a consideration for CAT. CAT should put no additional stress on the patient, nor should the Chinese herbal preparations used have any adverse interaction with any prescribed medication. While the USDA has some regulatory control with herbal preparations, it cannot set standards for their usage, because herbal preparations are considered supplements and not medication. Nationwide certification in Chinese medicine is not required for the practice of Chinese medicine. 5. The patient is utilizing complementary alternative therapy (CAT) with the combination of Western and Chinese medicine. The World Health Organization (WHO) has identified safety, efficacy, and quality as a consideration for CAT. CAT should put no additional stress on the patient, nor should the Chinese herbal preparations used have any adverse interaction with any prescribed medication. While the USDA has some regulatory control with herbal preparations, it cannot set standards for their usage, because herbal preparations are considered supplements and not medication. Nationwide certification in Chinese medicine is not required for the practice of Chinese medicine. Nursing/Int.Conc: Nursing Process: Evaluation Client Need: Safe and Effective Care Environment Cognitive Level: Safety and Infection Control Application Learning Outcome: ) A hospital in an urban area has been identified as delivering culturally competent care. What characteristic will be obvious when entering this organization? 1. Being aware of personal perspectives. 2. Treating all who utilize its services in the same manner. 3. Having conscious adaptation of care to the cultural context.

12 4. Providing services that are accepting and respectful of diverse populations. Answer: 4 Explanation: 4. An organization that is culturally competent displays acceptance and respect for other cultures. Its mission and policies support services for diverse populations and adherence to this is monitored. Treating all patients in the same manner is closer to cultural blindness. Conscious adaptation of care to the cultural context and awareness of personal perspectives are characteristics of individual cultural competence. Nursing/Int.Conc: Nursing Process: Assessment Cognitive Level: Analysis Learning Outcome: ) The health clinic staff is working on becoming culturally competent. Which strategies should the staff use when developing this competence? (Select all that apply.) 1. Increasing the diversity of the staff providing care. 2. Soliciting input from various cultural organizations. 3. Holding cultural training sessions for its staff members. 4. Developing a competence in the languages spoken by the patient population. 5. Concluding that their current method of care delivery needs little modification. Answer: 1, 2, 3, 4 Explanation: 1. Developing culturally competent care includes additional staff from diverse cultures, soliciting input from community cultural organizations, and holding training sessions for staff members, among other strategies. Developing culturally competent care would also involve analyzing their current care delivery for cultural appropriateness; it would still need modification in order to become truly culturally competent. Developing a

13 competence in the languages spoken by the patient population would allow for better communication and understanding between the health clinic staff and the patients seen. 2. Developing culturally competent care includes additional staff from diverse cultures, soliciting input from community cultural organizations, and holding training sessions for staff members, among other strategies. Developing culturally competent care would also involve analyzing their current care delivery for cultural appropriateness; it would still need modification in order to become truly culturally competent. Developing a competence in the languages spoken by the patient population would allow for better communication and understanding between the health clinic staff and the patients seen. 3. Developing culturally competent care includes additional staff from diverse cultures, soliciting input from community cultural organizations, and holding training sessions for staff members, among other strategies. Developing culturally competent care would also involve analyzing their current care delivery for cultural appropriateness; it would still need modification in order to become truly culturally competent. Developing a competence in the languages spoken by the patient population would allow for better communication and understanding between the health clinic staff and the patients seen. 4. Developing culturally competent care includes additional staff from diverse cultures, soliciting input from community cultural organizations, and holding training sessions for staff members, among other strategies. Developing culturally competent care would also involve analyzing their current care delivery for cultural appropriateness; it would still need modification in order to become truly culturally competent. Developing a competence in the languages spoken by the patient population would allow for better communication and understanding between the health clinic staff and the patients seen. Nursing/Int.Conc: Nursing Process: Implementation Learning Outcome: 5-6

14 16) A patient comes into the community clinic speaking a language in which there are no interpreters available. Which action should the population health nurse take to demonstrate cultural competence within the healthcare system? 1. Ask the patient to seek medical care in the community hospital. 2. Ask a staff member if they could attempt to communicate with the patient. 3. Communicate to the patient that an interpreter is not available and ask them to return tomorrow. 4. Contact a neighboring community health center to find out if their interpreter for this patient s language can be borrowed for a short time. Answer: 4 Explanation: 4. One system-level characteristics of cultural competence is interagency collaboration. Since an interpreter is not available at the community clinic, the nurse contacting a neighboring community health center to borrow an interpreter demonstrates this collaboration. Asking the patient to go to the community hospital or come back tomorrow does not demonstrate safe, quality, culturally competent care. Asking a staff member to try to communicate with the patient does not demonstrate culturally competent care. Nursing/Int.Conc: Nursing Process: Implementation Learning Outcome: ) The population health nurse is participating on a committee established to aid a multi-facility health center achieve cultural congruence. Which components should the nurse explain as being needed before the health center achieves this goal? (Select all that apply.) 1. Cultural diversity. 2. Cultural sensitivity. 3. Cultural awareness. 4. Cultural imposition. 5. Cultural competence. Answer: 1, 2, 3, 5

15 Explanation: 1. Culturally congruent care incorporates several components. These include cultural diversity, cultural awareness, cultural sensitivity, and cultural competence. Cultural diversity reflects the cultural differences that exist between health care professionals and a given population or cultural group. Cultural sensitivity involves assuming a learner role with respect to the culture of the population served. Cultural awareness encompasses providers recognition of the influence of culture on health and health-related behaviors. Cultural competence is actions taken by providers in response to awareness and knowledge, or the performance of culturally congruent behaviors by providers or health care systems. Cultural imposition is an expectation that others will conform to the dictates of one s own culture. 2. Culturally congruent care incorporates several components. These include cultural diversity, cultural awareness, cultural sensitivity, and cultural competence. Cultural diversity reflects the cultural differences that exist between health care professionals and a given population or cultural group. Cultural sensitivity involves assuming a learner role with respect to the culture of the population served. Cultural awareness encompasses providers recognition of the influence of culture on health and health-related behaviors. Cultural competence is actions taken by providers in response to awareness and knowledge, or the performance of culturally congruent behaviors by providers or health care systems. Cultural imposition is an expectation that others will conform to the dictates of one s own culture. 3. Culturally congruent care incorporates several components. These include cultural diversity, cultural awareness, cultural sensitivity, and cultural competence. Cultural diversity reflects the cultural differences that exist between health care professionals and a given population or cultural group. Cultural sensitivity involves assuming a learner role with respect to the culture of the population served. Cultural awareness encompasses providers recognition of the influence of culture on health and health-related behaviors. Cultural competence is actions taken by providers in response to awareness and knowledge, or the performance of culturally congruent behaviors by providers or health care systems. Cultural imposition is an expectation that others will conform to the dictates of one s own culture. 4. Culturally congruent care incorporates several components. These include cultural diversity, cultural awareness, cultural sensitivity, and cultural competence. Cultural diversity reflects the cultural differences

16 that exist between health care professionals and a given population or cultural group. Cultural sensitivity involves assuming a learner role with respect to the culture of the population served. Cultural awareness encompasses providers recognition of the influence of culture on health and health-related behaviors. Cultural competence is actions taken by providers in response to awareness and knowledge, or the performance of culturally congruent behaviors by providers or health care systems. Cultural imposition is an expectation that others will conform to the dictates of one s own culture. Nursing/Int.Conc: Nursing Process: Planning