Chapter 6: Cultural and Ethnic Considerations

What is a set of learned values, beliefs, customs, and practices taught, shared by a group, and passed from one generation to another?

1. Subculture

2. Ethnicity

3. Culture

4. Religion

Culture

When assessing a patient from a different culture, what is the most important area to consider?

1. Religious beliefs

2. Language spoken

3. Health practices

4. Social organizations

Language spoken

Rationale: It is important to determine whether the nurse and patient can understand what the other is saying.

The nurse is caring for a Muslim patient and knows that individuals of this religion pray several times a day. Which intervention is most appropriate in caring for this patient?

1. Schedule patient care around these prayer times.

2. Encourage the patient to plan prayers around treatments.

3. Activities take precedence over religious beliefs.

4. If the patient is praying, interrupt for care and allow him or her to finish later.

Schedule patient care around these prayer times.

Rationale: Religious beliefs should always be taken into consideration when providing patient care. Unless an emergency arises, allow prayer time to be finished and for care completed later.

A female Muslim patient has been assigned to a male nurse. As the nurse enters the room, the patient becomes very upset. The nurse understands this patient is upset because of what component of this patient's religious beliefs?

1. She does not think she is ill.

2. Her husband is not present.

3. She prefers to be taken care of by a female.

4. She cannot speak English.

She prefers to be taken care of by a female.

Rationale: Due to modesty, Muslim women prefer to be cared for by female staff, a preference that should be respected.

A Jehovah's Witness patient has been admitted to the medical floor. Which treatment will this patient most likely refuse based on religious beliefs?

1. Blood transfusion

2. Antibiotics

3. Cardiac medications

4. Aerosol treatments

Blood transfusion

Rationale: Jehovah's Witness believe blood transfusions violate God's law and therefore are not allowed.

Which patient problem is appropriate for a 35-year-old Hispanic patient who does not speak English?

1. Deficient knowledge

2. Noncompliance

3. Impaired verbal communication

4. Ineffective coping

Impaired verbal communication

Rationale: Impaired verbal communication occurs when there is a problem in the patient and staff understanding each other.

A Hispanic American child is brought to the clinic by her mother to be examined by the nurse health care provider. Which nursing intervention is most important when gathering data about the child?

1. Avoid using eye contact.

2. Be sure to touch the child during the examination.

3. Avoid any talking with the child.

4. Only use body language.

Be sure to touch the child during the examination.

Rationale: They believe women and children are susceptible to mal de ojo (evil eye). It is believed that touch will neutralize mal de ojo.

The nurse is doing discharge teaching with an African American patient regarding nutrition intake. What food customs should the nurse consider when developing this educational plan?

1. Raw fish is the main component of the diet.

2. Many meats and vegetables are fried in lard.

3. Red meat is the primary source of protein in the diet.

4. Rice is eaten with all meals.

Many meats and vegetables are fried in lard.

What are common characteristics seen among different cultures? (Select all that apply.)

1. Culture is learned from birth through language and socialization.

2. Culture is dynamic and everchanging, but it remains stable.

3. Members of the same cultural group have different patterns of socialization than other cultural groups.

4. Culture is an adaptation to specific conditions in a specific location.

5. Child-rearing practices are approximately the same in all cultures.

Culture is learned from birth through language and socialization.

Culture is dynamic and everchanging, but it remains stable.

Culture is an adaptation to specific conditions in a specific location.

All members of a culture will not have the same behavior. These variations are based on individual differences. Which interventions would address these differences? (Select all that apply.)

1. Schedule patient care around prayer time.

2. Provide meals as eaten by American influences.

3. Provide teaching in the language spoken.

4. Encourage family to participate in patient care.

5. Prevent children from visiting for infection control.

Schedule patient care around prayer time.

Provide teaching in the language spoken.

Encourage family to participate in patient care.

The nurse observes a young, friendly unlicensed assistive personnel (UAP) giving the "thumbs up" hand gesture as he passes by the doorway of his assigned patients. What would the nurse do first?

1. Ask the patients what they think about the "thumbs up" gesture.

2. Suggest that the UAP talk to the charge nurse before someone complains.

3. Observe the UAP for evidence of additional culturally biased behavior.

4. Talk to the UAP about the hand gesture and the response from the patients.

Talk to the UAP about the hand gesture and the response from the patients.

A nursing student has to rely on public transportation and she is late several times for class and clinical. The instructor is very unhappy with the tardiness. What should the student do first?

1. Promise never to be late for the remainder of the semester.

2. Ask for a transfer to another instructor and a different clinical site.

3. Explain transportation issues and ask for help to problem-solve.

4. Ask for lenience and offer to do additional make-up assignments.

Explain transportation issues and ask for help to problem-solve.

Which behavior most strongly suggests that the patient has a future time orientation?

1. Patient declines a recommended cancer screening test because she has no family history of cancer.

2. Patient goes to the emergency department for acute-onset abdominal pain.

3. Patient asks the nurse if his daughter can stay overnight with him in the hospital.

4. Patient initiates a program of regular exercise and healthy eating habits.

Patient initiates a program of regular exercise and healthy eating habits.

Rationale: Health promotion behaviors indicate future time orientation.

Which situation most strongly indicates a patriarchal family structure?

1. Oldest son makes medical decisions for older adult father and provides emotional support for his mother.

2. Family requests that diagnosis of cancer be withheld from the patient, who is an older adult female.

3. Female family members sit at the patient's bedside; male members sit in the waiting room.

4. At immunization clinic, mother gives her son emotional support and comfort.

Oldest son makes medical decisions for older adult father and provides emotional support for his mother.

Rationale: Patriarchal family: oldest male assumes leadership for family decision making.

Based on the nurse's knowledge of health disorders found among persons of American Indian ancestry, which question is the nurse most likely to ask?

1. "Have you experiences any unintentional weight loss?"

2. "Has anyone in your family ever been told they have diabetes?"

3. "When was the last time you had a complete physical?"

4. "Do you know if you have a family history of sickle cell disease?"

"Has anyone in your family ever been told they have diabetes?"

Rationale: American Indian ancestry have higher incidence of diabetes.

The nurse is assisting a patient to change position in bed. The patient has a limited understanding of English. What would the nurse do?

1. Speak loudly to emphasize key information.

2. Keep instructions brief and simple.

3. Wait for an interpreter.

4. Provide directions and detailed rationale.

Keep instructions brief and simple.

Which cultural differences does the nurse need to be aware of when caring for older adults? (Select all that apply)

1. They may be less tolerant of other cultures.

2. They may say hurtful things if cognitive impairment is present.

3. They are less likely to be well-educated.

4. They are more likely to use home remedies.

5. They belong to a cultural group of shared historical experiences.

They may be less tolerant of other cultures.

They may say hurtful things if cognitive impairment is present.

They are more likely to use home remedies.

They belong to a cultural group of shared historical experiences

The surgeon informs the patient about a risk of blood loss during the planned surgical procedure and advises that a blood transfusion may be needed during the surgery. The patient refuses to sign the consent form because of religious belief. Which nursing action is in the best interest of the patient?

1. Support of the patient's decision to refuse the procedure.

2. Discuss realistic alternatives to blood transfusion with the surgeon.

3. Document the patient's decision in the medical record.

4. Contact the risk manager for advice about convincing the patient.

Discuss realistic alternatives to blood transfusion with the surgeon.

Rationale: Alternative examples: non-blood plasma expanders, surgical techniques to decrease blood loss or autotransfusion.

To respect the Muslim woman's religious beliefs, what would the nurse do?

1. Provide privacy and a place to pray before each procedure.

2. Stay with the woman until a family member arrives.

3. Keep her head, arms, and legs covered as much as possible.

4. Have a female escort present if the health care provider (HCP) is male.

Keep her head, arms, and legs covered as much as possible.

The nurse is caring for a patient who is dying. What does evidence-based practice indicate about cultural beliefs and rituals that surround death?

1. The family should be encouraged to pray at the bedside.

2. Respect and protection of the dying person's soul are important.

3. Lack of religious preference increases problems with coping.

4. Rituals and ceremonies to delay or ward off death should be discouraged.

Respect and protection of the dying person's soul are important.

Rationale: Respect and protection of the soul were indicated by all study participants.

The patient, who is in no apparent distress, is accompanied to the clinic by several family members who cluster around. All are attempting to talk to each other and the nurse at the same time. The nurse can hear a mixture of English and another language being spoken. What would the nurse do first?

1. Try to determine who speaks the best English.

2. Escort the patient to an examination room and shut the door.

3. Project a calm manner and try to identify the leader of the family.

4. Physically assess the patient and take vital signs to ascertain conditions

Project a calm manner and try to identify the leader of the family.

Rationale: The leader can control the family.

A older male patient says to the nurse regarding the UAP, "That young Asian woman who helped me with my bath was really nice, but she seems scared and never looked up; just kept her head down. Did I do something to scare or offend her?" What would the nurse do first?

1. Find the UAP and ask her to explain her behavior to the patient.

2. Reassure him that he did nothing wrong and that the UAP's behavior is cultural.

3. Tell the patient that you will check with the UAP and then get back to him.

4. Apologize to the patient and give feedback to the UAP.

Tell the patient that you will check with the UAP and then get back to him.

Rationale: Assess the situation with the UAP first.

The nurse is a happy and outgoing person, and comes from a family where hugging, touching, patting, or playfully punching are part of normal everyday interaction. What is the best strategy for the nurse to combine her personal strengths and giving culturally appropriate care?

1. Assess her own behaviors and try to understand the origin of her personal style.

2. Consider different patient care settings and observe interactions.

3. Learn which cultures can accept touch by health care personnel.

4. Request to care for patients who are from her own culture.

Consider different patient care settings and observe interactions.

The nurse is working in an assisted-living facility and most residents take their meals in a common dining area. What is the best method for seating the residents?

1. Assign seating so that each resident has a consistent place at mealtimes.

2. Encourage the residents to continuously sit with someone new for stimulation.

3. Observe how self-mobile and ambulatory residents seat and group themselves.

4. Ask each resident where he/she would like to sit at the beginning of each meal.

Observe how self-mobile and ambulatory residents seat and group themselves.

The nurse is trying to give all of his patients the 9:00 AM medications. An older Hispanic woman needs 15 medications every morning but is consistently preoccupied whenever the nurse enters the room. What would the nurse do?

1. Administer the medications to other patients first and then help this patient.

2. Give the patient a 15-minute warning and then stick to the promised tie.

3. Try to find out why the woman is so consistently preoccupied.

4. Start giving this patient the medications at 8:00 AM so there is extra time.

Administer the medications to other patients first and then help this patient.

The nursing student is trying to explain the importance of taking blood pressure medication every day to an older patient who is on a fixed income. Which question from the patient is the best indication that his perception of time tends to be present-oriented?

1. "Can I save the medication on the days when I feel okay?"

2. "What should I do if I am running out of medication and have no money?"

3. "My wife takes blood pressure medication too. Can I share her pills?"

4. "Would you take this medication if you were in my position?"

"Can I save the medication on the days when I feel okay?"

Rationale: Present orientation is action that is guided by patients "feeling okay" in the moment.

The nurse is discussing the parents' beliefs and use of folk medicine, which they would like to use to treat their child's respiratory infection. Which health care practice is the cause for greatest concern?

1. Placing a religious medal on the bedside table.

2. Having a folk healer come to heal with touch and faith.

3. Giving the child an herbal tea that gives strength and health.

4. Bathing at night instead of in the morning.

Giving the child an herbal tea that gives strength and health.

Rationale: Herbal tea might have a bad reaction with the prescribed medications.

On visiting the patient at home, the nurse finds that the patient is not following the dietary instructions. The nurse discovers that the wife, who shops and cooks, believe that her husband needs "nutritious home-cooked meals from his native country." What would the nurse do first?

1. Change the dietary plan to meet the patient's and family's cultural preferences.

2. Consult a nutritionist for ways to adapt the wife's cooking to the dietary plan.

3. Revise the patient's nutritional goal to incorporate the cultural dietary patterns.

4. Ask the wife to describe a typical 24-hour day of meal preparation and snacks.

Ask the wife to describe typical 24-hour day of meal preparation and snacks.