Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13th 13e edition A+

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13th 13e edition A+

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13th 13e edition A+

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13th 13e edition A+

A nurse is meeting with a young woman who has recently lost her job after moving with her husband to a new city. She describes herself as being “anxious and pretty depressed.” What principle of stress and adaptation should be integrated into the nurse’s plan of care for this patient?
A)Adaptation often fails during stressful events and results in homeostasis.
B)Stress is a part of all lives, and, eventually, this young woman will adapt.
C)Acute anxiety and depression can be adaptations that alleviate stress in some individuals.
D)An accumulation of stressors can disrupt homeostasis and result in disease.
Four concepts—constancy, homeostasis, stress, and adaptation—are key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is disease. If a person is overwhelmed by stress, he or she may never adapt. Acute anxiety and depression are frequently associated with stress.

2.You are the nurse caring for an adult patient who has just received a diagnosis of prostate cancer. The patient states that he will “never be able to cope with this situation.” How should you best understand the concept of coping when attempting to meet this patient’s needs?
A)Coping is a physiologic measure used to deal with change, and he will physically adapt.
B)Coping is composed of the physiologic and psychological processes that people use to adapt to change.
C)Coping is the human need for faith and hope, both of which create change.
D)Coping is a social strategy that is used to deal with change and loss.
Indicators of stress and the stress response include both subjective and objective measures. They are psychological, physiologic, or behavioral and reflect social behaviors and thought processes. The physiologic and psychological processes that people use to adapt to stress are the essence of the coping process. Coping is both a physiologic and psychological process used to adapt to change. Coping is a personal process used to adapt to change.

3.The nurse is with a patient who has learned that he has glioblastoma multiforme, a brain tumor associated with an exceptionally poor prognosis. His heart rate increases, his eyes dilate, and his blood pressure increases. The nurse recognizes these changes as being attributable to what response?
A)Part of the limbic system response
B)Sympathetic nervous response
C)Hypothalamic-pituitary response
D)Local adaptation syndrome
The sympathetic nervous system responds rapidly to stress; norepinephrine is released at nerve ending causing the organs to respond (i.e., heart rate increases, eyes dilate, and blood pressure increases). The limbic system is a mediator of emotions and behavior that are critical to survival during times of stress. The hypothalamic-pituitary response regulates the cortisol-induced metabolic effect that results in elevated blood sugars during stressful situations. Local adaptation syndrome is a tissue-specific inflammatory reaction.

4.You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on the postsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that her blood sugars are elevated, yet diabetes does not appear in her previous medical history. To what do you attribute this elevation in blood sugars?
A)It is a temporary result of increased secretion of antidiuretic hormone.
B)She must have had diabetes prior to surgery that was undiagnosed.
C)She has suffered pancreatic trauma during her abdominal surgery.
D)The blood sugars are probably a result of the “fight-or-flight” reaction.
During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress-induced hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes.

5.A patient tells the nurse that she does not like to “go to the doctor” and is feeling anxious about “being in this place.” When the nurse checks her blood pressure, it is elevated along with her heart rate. The nurse rechecks her blood pressure about 10 minutes later and it is normal. The patient asks the nurse if she should be concerned that she may have hypertension. What statement should guide the nurse’s response?
A)She should not worry; it was stress related and her regular blood pressure is good.
B)The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.
C)Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis.
D)The respiratory infection is the probably the cause of the elevated blood pressure, and, with treatment, her blood pressure should remain normal.
A simple stress response will temporarily elevate a blood pressure and heart rate. Long-term blood pressure response is controlled by negative feedback systems.

For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patient’s blood pressure is good based on only two blood pressure readings. The stress of a respiratory infection could account for the elevated blood pressure, but assuring the patient that, with treatment, her blood pressure will return to normal may not be true.

6.A patient presents to the health center and the nurse practitioner’s assessment reveals an enlarged thyroid. The nurse practitioner believes the thyroid cells may be undergoing hyperplasia. How would the nurse practitioner explain this condition to the patient?
A)Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer.
B)Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell growth removed.
C)Hyperplasia is the change in appearance of the thyroid due to a chronic irritation and will reverse with the stimulus removed.
D)Hyperplasia is a cancerous growth and will be removed surgically.
Hyperplasia is an increase in the number of new cells in an organ or tissue. This is due to increased mitotic stimulation from the additional cell division, and this, in turn, enlarges the tissue. Hyperplasia is reversible when the stimulus for cell growth is removed. Hyperplasia is the increase in the number of new cells, not a change in size or appearance. Hyperplasia is the increase in the number of new cells, which may or may not be cancerous growth.

7.A mother has brought her young son to the emergency department (ED). The mother tells the triage nurse that the boy was stung by a bee about an hour ago. The mother explains to the nurse, “It hurts him so bad and it looks swollen, red, and infected.” What can the triage nurse teach the mother?
A)The pain, redness, and swelling are part of the inflammatory process, but it is probably too early for an infection.
B)Bee stings frequently cause infection, pain, and swelling, and, with treatment, the infection should begin to subside late today.
C)The infection was probably caused by the stinger, which may still be in the wound.
D)The mother’s assessment is accurate and the ED doctor will probably prescribe antibiotics to fix the problem.
Cells or tissues of the body may be injured or killed by any agent (physical, chemical, infectious). When this happens, an inflammatory response (or inflammation) naturally occurs in the healthy tissues adjacent to the injury site. Inflammation is not the same as infection. An infectious agent is only one of several agents that may trigger an inflammatory response. Although bee stings may cause infection, the signs and symptoms (very painful, looks swollen and red) result from the acute inflammatory response. If the stinger were still in the wound, it would only be creating inflammation, not infection. Antibiotics are not indicated.

8.You are caring for an older female patient who is being treated for acute anxiety. She has a nursing diagnosis of Ineffective Coping related to a feeling of helplessness. What would be the most appropriate nursing intervention?
A)Put the primary onus for planning care on the patient herself.
B)Assess and provide constructive outlets for anger and hostility.
C)Assess the patient’s sources of social support.
D)Encourage an attitude of realistic hope to help her deal with helpless feelings.
By encouraging an attitude of realistic hope, the patient will be empowered. This allows the patient to explore her feelings and bring about more effective coping patterns. The onus for care planning should not lie with the patient. The nursing diagnosis is related to feeling of helplessness, not anger and hostility. Social support is necessary, but does not directly address the feeling of helplessness.

9.A 35-year-old woman comes to the local health center with a large mass in her right breast. She has felt the lump for about a year, but was afraid to come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this patient?
A)Self-esteem disturbance related to late diagnosis
B)Ineffective individual coping related to reluctance to seek care
C)Altered family process related to inability to obtain treatment
D)Ineffective denial related to reluctance to seek care
Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case, the patient was unable to access health care even when she was aware the disorder could be life-threatening. Self-esteem Disturbance, Altered Family Process, and Ineffective Denial are all nursing diagnoses that are often associated with breast cancer, but the patient’s ineffective individual coping has created a significant safety risk and is, therefore, the most appropriate nursing diagnosis.

10.The nurse at the student health center is seeing a group of students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What will be included in the nurse’s intervention?
A)The use of progressive tensing and relaxing of muscles to release tension in each muscle group
B)Using a positive self-image to increase and intensify physical exercise, which decreases stress
C)The mindful use of a word, phrase, or visual, which allows oneself to be distracted and temporarily escape from stressful situations
D)The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations
Guided imagery is the mindful use of a word, phrase, or visual image to distract oneself from distressing situations or consciously taking time to relax or reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or humor.

11.The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The nurse asks the patient how long these nodes have noticeably enlarged. The patient states, “I can’t remember. A long time I think. Do I have cancer?” Which of the following is an immediate physiologic response to stress the nurse would expect this patient to experience?
A)Vasodilation of peripheral blood vessels
B)Increased blood pressure
C)Decrease in blood glucose levels
D)Pupil constriction
An initial response to stress, as seen by the fight-or-flight response, is an increase in the patient’s heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.

12.Your patient tells you that he has just been told that his computed tomography results were abnormal. You can expect that his sympathetic nervous system has stimulated his adrenal gland to release what?
In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine.

13.You walk into your patient’s room and find her sobbing uncontrollably. When you ask what the problem is, your patient responds, “I am so scared. I have never known anyone who goes into a hospital and comes out alive.” On this patient’s care plan you note a pre-existing nursing diagnosis of Ineffective Coping related to stress. What is the best outcome you can expect for this patient?
A)Patient will adopt coping mechanisms to reduce stress.
B)Patient will be stress free for the duration of treatment.
C)Patient will avoid all stressful situations.
D)Patient will be treated with an antianxiety agent.
Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping.

14.The nurse is assessing a patient and learns that the patient and his wife were married just 3 weeks earlier. Which of the following statements should underlie the nurse’s care planning for this patient?
A)The patient and spouse should seek counseling to ease their transition.
B)The patient will have better coping skills being in a stable relationship.
C)Happy events do not normally cause stress.
D)Marriage causes transition, which has the potential to cause stress.
Transition can contribute to stress, even if the transition is a positive change. The third group of stressors has been studied most extensively and concerns relatively infrequent situations that directly affect people. This category includes the influence of life events such as death, birth, marriage, divorce, and retirement. Counseling is not necessarily indicated.

15.The nurse is assessing a newly admitted patient who is an 84-year-old woman. The nurse learns that the patient has simultaneously experienced a hip fracture and the exacerbation of her chronic heart failure. What is an example of a bodily function that restores homeostasis by negative feedback when conditions shift out of normal range?
A)Body temperature
B)Pupil dilation
D)Blood clotting
Negative feedback mechanisms throughout the body monitor the internal environment and restore homeostasis when conditions shift out of normal range. Body temperature, blood pressure, and acid-base balances are examples of functions regulated by these compensatory mechanisms. Blood clotting in the body involves positive feedback mechanisms. Pupil dilation and diuresis are not modulated by negative feedback mechanisms.

16.A patient who has a 40 pack-year history of smoking may have dysplasia of the epithelial cells in her bronchi. What would the nurse tell the patient about dysplastic cells in the bronchi?
A)This is a benign process that occurs as lung tissue regenerates.
B)Dysplastic cells have a high potential to become malignant.
C)This process involves a rapid increase in number of cells.
D)Dysplasia may cause uncontrolled growth of scar tissue.
Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same tissue type. Dysplastic cells have a tendency to become malignant; dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke. This may not be a harmless condition and dysplasia does not cause scar tissue. Hyperplasia is an increase in the number of new cells.

17.A teenage boy who was the victim of a near drowning has been admitted to the emergency department. The patient was submerged for several minutes and remains unconscious. What pathophysiological process has occurred as a result of the submersion?
A)Atrophy of brain cells
B)Cellular lysis
C)Hypoxia to the brain
D)Necrosis to the brain
The length of time different tissues can survive without oxygen varies. The brain will become hypoxic in 3 to 6 minutes. The other options are incorrect because submersion injuries do not cause atrophy to brain cells right away; submersion injuries also do not cause cellular lysis or necrosis to the brain.

18.Your older adult patient has been diagnosed with urosepsis and has a temperature of 103.4°F. You should be aware that the oxygen demands of the patient’s body would change in which direction and why?
A)Increase due to an increase in metabolism
B)Decrease due to a decrease in metabolism
C)Increase due to a decrease in metabolism
D)Decrease due to an increase in metabolism
When a person’s temperature is elevated, hypermetabolism occurs, and the respiratory rate, heart rate, and basal metabolic rate increase. The other options are incorrect because oxygen demands would not decrease and they would not increase due to a decrease in metabolism.

19.You are admitting a patient who presents with inflammation of his right ankle. When planning this patient’s care, which of the following statements regarding acute inflammation should you recognize?
A)Inflammation is essentially synonymous with infection.
B)Inflammation may impair the healing process.
C)Inflammation is a defensive reaction intended to remove an offending agent.
D)Inflammation inhibits the release of histamines in the tissues.
Inflammation is a defensive reaction intended to remove an offending agent and prepare the site for repair. Inflammation is not the same as infection, it does not impair the healing process, and it does not inhibit the release of histamines in the tissues.

20.An elderly man tells you that his wife died 14 months ago and that he cannot stop grieving over his loss. What should you encourage the patient to consider?
A)Improve his nutritional intake.
B)Make an appointment at a wellness clinic.
C)Walk on a daily basis.
D)Increase his interaction with his social network.
Social networks can reduce stress by providing the individual with a positive social identity, emotional support, material aide, information, and new social contacts. Changes to diet and activity may be beneficial, but social interaction is known to be of particular benefit. Attendance at a wellness clinic may or may not be beneficial, and does not involve social interaction.

21.You are caring for a 65-year-old widower whose wife died 4 months ago. He tells you that he is “not doing well” and that his friends and family seem hesitant to talk with him about his wife. What could the nurse do to help the patient?
A)Refer him to a consciousness-raising group.
B)Refer him to a psychiatrist.
C)Refer him to a support group.
D)Refer him to a church or temple.
Being a member of a group with similar problems or goals has a releasing effect on a person that promotes freedom of expression and exchange of ideas. Psychiatry may or may not be necessary. Spiritual assessment would necessarily precede any referral to a specific religious setting. Consciousness-raising groups are not known to be a common source of social support.

22.A 44-year-old woman will undergo a bilateral mastectomy later today and the nurse in surgical admitting has begun the process of patient education. What positive outcome of providing the patient with information should the nurse expect?
A)Increased concentration
B)Decreased depression levels
C)Sharing of personal details
D)Building interdependent relationships
Giving patients information also reduces the emotional response so that they can concentrate and solve problems more effectively. Educating the patient does not decrease depression levels or build interpersonal relationships. Educating the patient does not mean sharing of personal details.

23.You are the nurse caring for a 51-year-old man who has just been told in a family meeting that he has stage IV colon cancer. You expect that the patient now has an increase in blood pressure, heart rate and respiratory rate. You spend time talking with this patient and his vital signs become closer to normal range. To what would you attribute this phenomenon?
A)Cortisol levels are decreasing.
B)Endocrine activity has increased.
C)The patient is adapting to noxious stressors.
D)The sympathetic response has been activated.
Selye developed a theory of adaptation to biologic stress that he named the general adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During the alarm phase, the sympathetic “fight-or-flight” response is activated with release of catecholamines and the onset of the adrenocorticotropic hormone (ACTH) – adrenal cortical response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living in a continuous state of alarm would result in death, people move into the second stage, resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased. If exposure to the stressor is prolonged, the third stage, exhaustion, occurs. During the exhaustion stage, endocrine activity increases, and this has negative effects on the body systems (especially the circulatory, digestive, and immune systems) that can lead to death.

24.While talking with the parents of conjoined twins who are medically unstable, you note that the father of the babies has an aggressive stance, is speaking in a loud voice, and makes several hostile statements such as, “I’d sure like to have words with that doctor who told us our babies would be okay.” You know that this father’s cognitive appraisal has led to what?
A)Harm/loss feelings
B)Feelings of challenge
C)A positive adjustment to the possible loss of his children
D)The development of negative emotions
The appraisal process contributes to the development of an emotion. Negative emotions, such as fear and anger, accompany harm/loss appraisals, and positive emotions accompany challenge. Harm and challenge are not feelings, so the corresponding options are incorrect. There is nothing in the scenario that indicates that the father is making a positive adjustment to the possible loss of his children.

25.The nurse is caring for a patient who was widowed 2 years prior to this current hospitalization, her fifth since the death of her husband. The woman says to the nurse, “The doctor says my blood pressure is dangerously high. What is making my blood pressure so high?” What does the nurse know about the probable cause of this patient’s hypertension?
A)Prolonged or unrelenting suffering can cause physical illness.
B)Physical illness is always caused by prolonged stress.
C)The elderly are at increased risk for hypertension due to stress.
D)Stress always exacerbates the physiologic processes of the elderly.
When a person endures prolonged or unrelenting suffering, the outcome is frequently the development of a stress-related illness. Physical illness is not always caused by prolonged stress. The elderly population is not the only population at increased risk for hypertension due to stress. Stress does not always exacerbate the physiologic processes of the elderly. This is an absolute statement, and true absolutes are rare.

26.You are the psychiatric-mental health nurse caring for a young, recently married woman, whose sister and niece were recently killed in a motor vehicle accident. This young woman is making arrangements for the funerals, and you know that your patient has insight into her current stressors. What do you know is occurring with this young woman?
A)The mediating process is occurring.
B)The patient is experiencing an expected level of denial.
C)The patient’s awareness of her stress makes it more acute.
D)The patient is emotionally overwhelmed.
After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed the mediating process. Nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Awareness of stress does not necessarily exacerbate it.

27.As an occupational health nurse at a large industrial plant, you are planning the return to work of an employee who was exposed to a chemical spill. To what type of stressor has this patient been exposed?
Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. A chemical spill is neither a psychiatric nor a psychosocial phenomenon.

28.You are caring for a patient in the urgent care center who presented with complaints of lethargy, malaise, aching, weakness, and loss of appetite. During the assessment, you note an area on the patient’s right posterior calf that is warm to touch, edematous, and tender to touch. You know the most probable cause of this patient’s symptoms is what?
A)Local inflammatory response
B)Systemic shock response
C)Local infectious response
D)Systemic inflammatory response
The inflammatory response is often confined to the site, causing only local signs and symptoms. However, systemic responses can also occur. During this process, general, nonspecific symptoms develop, including malaise, loss of appetite, aching, and weakness. The fact that the patient is experiencing systemic effects such as lethargy, malaise, aching, weakness, and loss of appetite suggests that inflammation is not limited to one specific site.

29.You are discharging a 4-year-old boy from the emergency department. The boy was seen for an insect bite that became swollen and reddened and warm and painful to touch. The patient’s vital signs are all within normal range for age. While giving discharge instructions to the patient’s father, he asks why the child is not going to get antibiotics for the infected insect bite. What would be your best response?
A)“This is a local inflammatory response to the insect bite; it is not an infection so antibiotics will not help.”
B)“In children who are previously healthy, inflammation and infections usually resolve without the need for drugs.”
C)“I’ll make sure the doctor is made aware that you’d like your son to have a course of antibiotics.”
D)“Infection is not the same as inflammation. What your son has is inflammation.”
Regardless of the cause, a general sequence of events occurs in the local inflammatory response. This sequence involves changes in the microcirculation, including vasodilation, increased vascular permeability, and leukocytic cellular infiltration. As these changes take place, five cardinal signs of inflammation are produced: redness, heat, swelling, pain, and loss of function. Infections do not always resolve spontaneously. The nurse should teach the patient’s father about the reasons that antibiotics are unnecessary rather than simply deferring to the physician.

30.A group of nursing students are applying the concept of steady state to the nursing care plan of a patient who is undergoing chemotherapy and radiotherapy for the treatment of lung cancer. What would be the most complete statement by the students about the concept of steady state?
A)“The concept of steady state preserves life.”
B)“The mechanisms of steady state work to maintain balance in the body.”
C)“This concept compensates for biologic and environmental attacks on the body.”
D)“Steady state is the same as adaptation.”
Mechanisms for adjusting internal conditions promote the normal steady state of the organism and its survival. These mechanisms are compensatory in nature and work to restore balance in the body. Adaptation is a part of the concept of steady state; it is not the concept itself.

31.A nursing student has presented a concept map of a medical patient’s health that demonstrates the maintenance of a steady state. The student has elaborated on the relationship of individual cells to compensatory mechanisms. When do compensatory mechanisms occur in the human body?
A)According to a diurnal cycle
B)When needed
The concept of the cell as existing on a continuum of function and structure includes the relationship of the cell to compensatory mechanisms, which occur continuously in the body to maintain the steady state.

32.A nurse is planning the care of a woman who has been admitted to the medical unit following an ischemic cerebrovascular accident. What would the nurse recognize as the longest-acting phase of the woman’s physiologic response to stress and its cause?
A)Sympathetic-adrenal-medullary response caused by persistent stress
B)Hypothalamic-pituitary response caused by acute stress
C)Sympathetic-adrenal-medullary response caused by acute stress
D)Hypothalamic-pituitary response caused by persistent stress
The longest-acting phase of the physiologic response, which is more likely to occur in persistent stress, involves the hypothalamic-pituitary pathway, not the sympathetic-adrenal-medullary pathway.

33.Selyes’ general adaptation syndrome (GAS) is a theory of adaption to biologic stress. Selye compared the GAS with the life process: childhood, adulthood, and later years. What would occur during “adulthood” in the GAS?
A)Stressful events occur and resistance or adaption occurs.
B)Successful avoidance of stressful life events leaves the body vulnerable.
C)The accumulation of life’s stressors causes resistance to fall.
D)Vulnerability leads to eventual death.
Selye compared the general adaptation syndrome with the life process. During childhood, too few encounters with stress occur to promote the development of adaptive functioning, and children are vulnerable. During adulthood, a number of stressful events occur, and people develop resistance or adaptation. During the later years, the accumulation of life’s stressors and wear and tear on the organism again decrease people’s ability to adapt, so resistance falls, and, eventually, death occurs. Based on this comparison, options B, C, and D are incorrect.

34.You are auditing the electronic health record of a 33-year-old patient who was treated for a postpartum hemorrhage. When reviewing the patient’s records, you can see various demonstrations of negative feedback loops. Which of the following constitute negative feedback loops? Select all that apply.
A)Serum glucose levels
B)Acid-base balance
D)Blood clotting
E)Labor onset
Ans:A, B, C
These mechanisms work by sensing deviations from a predetermined set point or range of adaptability and triggering a response aimed at offsetting the deviation. Blood pressure, acid–base balance, blood glucose level, body temperature, and fluid and electrolyte balance are examples of functions regulated through such compensatory mechanisms. Coagulation and labor onset are results of positive feedback loops.

35.A group of nurses are planning the care of an older adult who is being rehabilitated following a stroke. A nurse notes that hypertension and cardiovascular disease could have occurred over time if the patient previously experienced a state of chronic arousal. In a state of chronic arousal, what can happen within the body?
A)Blood pressure decreases.
B)Serum glucose levels drop.
C)Arteriosclerosis may develop.
D)Tissue necrosis may occur.
If the sympathetic-adrenal-medullary response is prolonged or excessive, a state of chronic arousal develops that may lead to high (not low) blood pressure, arteriosclerotic changes, and cardiovascular disease. If the production of ACTH is prolonged or excessive, behavior patterns of withdrawal and depression are seen. In addition, the immune response is decreased, and infections and tumors may develop.

36.A group of nurses are attending an educational inservice on adaptive and maladaptive responses to stress. When talking about the assessment of coping strategies in patients, the nurses discuss the use of drugs and alcohol to reduce stress. What is most important for the nurses to know about these coping behaviors?
A)They are effective, but alternative, coping behaviors.
B)They do not directly influence stress in the body.
C)They are adaptive behaviors.
D)They increase the risk of illness.
Coping processes that include the use of alcohol or drugs to reduce stress increase the risk of illness. The use of drugs and alcohol as a means to reduce stress are not effective coping behaviors. They are maladaptive behaviors, even though they have a short-term effect on stress.

37.You are assessing an older adult patient post-myocardial infarction. You attempt to identify your patient’s health patterns and to assess if these health patterns are achieving the patient’s goals. How should you best respond if it is found that the patient’s health patterns are not achieving their goals?
A)Seek ways to promote balance in the patient.
B)Refer the patient to social work.
C)Identify alternative models of health care.
D)Provide insight into the patient’s physiological failings.
The nurse has a significant role and responsibility in identifying the health patterns of the patient receiving care. If those patterns are not achieving physiologic, psychological, and social balance, the nurse is obligated, with the assistance and agreement of the patient, to seek ways to promote balance. The nurse is not obligated to refer to social work, identify alternative forms of care, or provide insight into the physiologic failings of the system if the patient’s health patterns are not achieving their goals.

38.A patient is experiencing intense stress during his current hospital admission for the exacerbation of chronic obstructive pulmonary disease (COPD). Which of the patient’s actions best demonstrates adaptively coping?
A)Becoming controlling
B)Reprioritizing needs and roles
C)Using benzodiazepines as ordered
Adaptive ways of coping included seeking information, reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself to others, planning activities to conserve energy, taking things one step at a time, listening to one’s body, and using self-talk for encouragement. Becoming controlling or withdrawing are not ways to cope adaptively. Benzodiazepines are sometimes indicated, but these are not considered to be an adaptive coping behavior.

39.The nurse is performing discharge planning for a patient who has numerous chronic health problems. The nurse recognizes that lifestyle changes would likely benefit the patient’s health status. Which factor would the nurse identify as most important in determining health status?
C)Social class
D)Interfamilial relationships
The single most important factor for determining health status is social class and, within a social class, the research suggests that the major factor influencing health is level of education. This factor supersedes the importance of ethnicity, gender, or interfamilial relationships.

40.The nurse is admitting a 51-year-old patient to the medical-surgical unit after a diagnosis of cellulitis of the calf. What factors does the nurse know impact the processes of inflammation, repair, and replacement? Select all that apply.
A)Severity of the injury
B)Social relationships
C)Condition of the host
D)Familial support
E)Nature of the injury
Ans:A, C, E
The condition of the host, the environment, and the nature and severity of the injury affect the processes of inflammation, repair, and replacement. The patients’ social relationships and familial support do not directly affect the processes of inflammation, repair, and replacement.

Chapter 7

1.In a small, rural hospital the nurse is caring for a patient who speaks a language other than English. The nurse needs to use an interpreter to communicate but the hospital does not have access to an interpreter who speaks the patient’s language. When choosing another individual to interpret for this patient, what characteristic should the nurse prioritize?
A)Interpreter should recognize the need to speak in a loud voice.
B)Interpreter should be able to conduct the conversation quickly to avoid misinterpretation.
C)Interpreter should be fluent in several dialects of the patient’s language.
D)Interpreter should know that repetition must be avoided while interpreting.
Cultural needs should be considered when choosing an interpreter; for instance, fluency in varied dialects is beneficial. In choosing an interpreter, you do not want one who speaks in an excessively loud voice, conducts the conversation too quickly, or avoids repetition.

2.You are a community health nurse who provides care to a group of Hispanic people living in an area that is predominantly populated by Caucasian people. How would you characterize the Hispanic people in this community?
A)An underclass
B)A subgroup
C)A minority
D)An exception
The term minority refers to a group of people whose physical and cultural characteristics differ from the majority of people in a society. There are four generally identified minority groups: Blacks/African Americans, Hispanics, Asian/Pacific Islanders, and Native Americans. Such groups are not referred to as exceptions or underclasses. A subgroup is a division of a group that is in some way distinguished from the larger group.

3.A nurse is caring for an elderly woman who predominantly identifies with an East Asian culture. How can the nurse best demonstrate an awareness of culturally congruent care?
A)Maintain eye contact at all times.
B)Try to speak the patient’s native language.
C)Use touch when communicating.
D)Establish effective communication.
Establishment of an environment of culturally congruent care and respect begins with effective communication, which occurs not only through words, but also through body language and other cues, such as voice, tone, and loudness. Not all cultures are comfortable with eye contact. Unless you are fluent in the patient’s native language, trying to communicate in that language would not be effective communication. Not all cultures incorporate touch while communicating.

4.Most nurses have been taught to maintain direct eye contact when communicating with patients. However, some cultural groups do not usually value direct eye contact when communicating with the nurse. Which cultural group would most likely consider the direct eye contact impolite?
A)African Americans
D)Native Americans
Eye contact is a culturally determined behavior. Although most nurses have been taught to maintain eye contact when speaking with patients, some people from certain cultural backgrounds may interpret this behavior differently. For example, some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians may consider direct eye contact impolite or aggressive, and they may avert their own eyes when talking with nurses and others whom they perceive to be in positions of authority.

5.An emergency department nurse is preparing to inspect and palpate the head and scalp of an older adult who experienced a fall. A member of which group would most likely consider this examination as a violation of norms?
B)Asian American
D)African American
For many Asian Americans, it is impolite to touch the patient’s head because the spirit is believed to reside in the head. Therefore, assessment of the head or evaluation of a head injury requires permission of the patient, or a family member if the patient is not able to give permission. This is not the case with the other listed groups.

6.The nurse is helping a patient choose her menu options for the following day. The nurse reads out the option of ham with scalloped potatoes and the patient states that her religion does not allow this. Which of the following is most likely the patient’s religion?
A)Roman Catholicism
Many Islamic people abstain from eating pork. Members of other religions also proscribe the consumption of meat in general, or pork in particular, but the other listed religions are not among these.

7.The nurse is preparing a discharge teaching session with an Asian patient to evaluate the patient’s ability to change a dressing. The patient speaks and understands minimal English. What would be the best way to promote understanding during the teaching session?
A)Ask the patient to repeat the instructions carefully.
B)Write the procedure out for the patient in simple language.
C)Use an interpreter during the teaching session.
D)Have the patient demonstrate the dressing change.
Policies that promote culturally competent care establish flexible regulations pertaining to visitors (number, frequency, and length of visits), provide translation services for non–English-speaking patients, and train staff to provide care for patients with different cultural values. Writing instructions, having the patient demonstrate the procedure, and asking the patient to repeat instructions do not adequately compensate for the communication barrier that exists.

8.You are the nurse caring for a patient who is a recent immigrant to the United States from Mexico. Which of the following variables would you prioritize when performing an assessment of the patient’s cultural beliefs?
A)Patient’s previous medical history
B)Patient’s marital status
C)Patient’s age
D)Patient’s communication style
Assessment of a patient’s culture should include the patient’s country of origin, language (communication style), food preferences or restrictions, health maintenance practices, and religious preferences and practices. This aspect of assessment does not explicitly include the patient’s support systems, marital status, or age, though each of these parameters would be assessed at different points.

9.You are caring for a patient who is terminally ill whose family has requested to hold a spiritual ceremony during which they will be using incense. What would be the best intervention you could make on behalf of this patient?
A)Discourage the use of incense in the hospital.
B)Ask the family to have the ceremony off the unit.
C)Arrange for the ceremony to occur after notifying all departments affected.
D)Encourage the family to conduct the ceremony elsewhere because it may affect other patients in the unit.
Culturally competent policies are developed to promote an environment in which the traditional healing, spiritual, and religious practices of patients are respected and encouraged and to recognize the special dietary practices of patients from selected cultural groups. To promote spirituality and transcultural nursing, the nurse should make or help to make the arrangements. The nurse should not attempt to dissuade the family or to relegate the ceremony to a site outside the hospital.

10.A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects. The nurse’s behavior is an example of what?
B)Cultural blindness
C)Cultural imposition
D)Cultural taboos
The nurse’s behavior is an example of cultural imposition, defined as the tendency to impose one’s cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.

11.An infant with a diagnosis of pyelonephritis is receiving care on the pediatric unit and the nurse’s review of the child’s electronic health record reveals that the infant has not received any of her scheduled immunizations. The mother informs the nurse that immunizations are against her cultural beliefs, and she does not want her child to receive immunizations. In this scenario, what do the mother’s views on immunizations represent?
B)Cultural blindness
C)A cultural imposition
D)A cultural taboo
Immunizations in this scenario are a cultural taboo. Cultural taboos are defined as activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is defined as the tendency to impose one’s cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies.

12.In planning the nursing care of a patient who lives with chronic pain, the nurse has included the intervention of therapeutic touch. When categorizing this particular complementary therapy, the nurse should identify it as which of the following?
A)A biologically based therapy
B)A mind-body intervention
C)A manipulative and body-based method therapy
D)An energy therapy
Therapeutic touch is an example of an energy therapy. Biologically based therapies include herbal therapies, special diet therapies, orthomolecular therapies, and biologic therapies. Mind-body interventions include meditation, dance, music, art therapy, prayer, and mental healing. Manipulative and body-based methods include chiropractic, massage therapy, osteopathic manipulation, and reflexology. The other options are incorrect because they are not examples of energy therapy.

13.You are admitting a patient who is a recent immigrant from China and who has a diagnosis of adenocarcinoma. During the patient’s admission assessment, the patient speaks of her beliefs related to health care and indirectly references the yin/yang theory. Based on her cancer diagnosis and her yin/yang beliefs, which meal will the patient most likely order for lunch?
A)Chicken noodle soup with crackers, fruit crisp, and hot tea
B)Turkey sandwich, small tossed salad, and iced tea
C)Chef’s salad, bread, and water
D)Fruit smoothie and granola bar
Foods are classified as cold (yin) and hot (yang) in the naturalistic or holistic perspective. In this theory, foods are transformed into yin and yang energy when metabolized by the body. Hot foods are eaten when a person has a cold illness such a cancer, headache, stomach cramps, and a “cold.” Based on this information, the patient would select chicken noodle soup with crackers, fruit crisp, and hot tea as these are hot foods. The other options are cold foods and are eaten when a patient has a hot illness such as a fever, rash, sore throat, ulcer, or infection.

14.The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes to the unit. During the initial assessment, the patient informs the nurse that he has been seeking assistance and care from the shaman in his community. The nurse recognizes that the patient’s blood pressure and his blood sugar level are elevated upon admission. What is the nurse’s best response to the patient’s indication that his care provider is a shaman?
A)“Thank you for providing the information about the shaman, but we will keep that information and approach separate from your current hospitalization.”
B)“It seems that the care provided by your shaman is not adequately managing your hypertension and diabetes, so we will try researched medical approaches.”
C)“Don’t worry about insulting your shaman, as he will understand his approach to your hypertension and diabetes was not working after your doctor tells him how sick you were in the hospital.”
D)“I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may lower your blood pressure and blood sugar levels.”
Native American patients may seek assistance from a shaman or medicine man or woman. The nurse’s best approach is not to disregard the patient’s belief in folk healers or try to undermine trust in the healers. Nurses should make an effort to accommodate the patient’s beliefs while also advocating the treatment proposed by health science. The nurse’s best response incorporating these strategies is, “I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may improve your blood pressure and blood sugar levels.”

15.The nurse is providing care for an older adult patient who has a diagnosis of shingles. The nurse is aware that this health problem is attributable to the varicella zoster virus. This belief is an example of which paradigm explaining the cause of disease and illness?
The biomedical or scientific perspective assumes that all events in life have a cause and effect and that all of reality can be observed and measured. One example of the biomedical or scientific view is the bacterial or viral explanation of communicable diseases. The naturalistic or holistic view states that forces of nature must be kept in natural balance or harmony. “Factual” is not a recognized category of beliefs.

16.In your role as a community health nurse, you are focusing your current health promotion efforts on diseases that are disproportionately represented among ethnic and racial minorities. Which of the following diseases would you likely address? Select all that apply.
A)Human immunodeficiency virus (HIV)
C)Heart disease
D)Chronic obstructive pulmonary disease (COPD)
E)Alzheimer’s disease
Ans:A, B, C
Ethnic and racial minorities are disproportionately burdened with cancer, heart disease, diabetes, human immunodeficiency virus (HIV), infection/acquired immunodeficiency syndrome (AIDS), and other conditions. COPD and Alzheimer’s disease are incorrect because health care disparities have not been noted with these two diseases.

17.Prior to planning health promotion interventions in your local community, you are appraising the key health care indicators in your region and comparing them with those in the nation as a whole. What do these key indicators reveal about the United States?
A)A significant gap in health status between the overall population and people of specific ethnic backgrounds
B)A significant gap in health care delivery between the overall population and subgroups of the minority populations
C)A significant gap in health status between the Hispanic population and the Native American population
D)A significant gap in health care delivery between the Asian American population and the Pacific Islander population
Key health indicators in the United States reveal a significant gap in health status between the overall American population and people of specific ethnic backgrounds. Option B is incorrect because key health care indicators do not show a gap in health care delivery between the overall population and subgroups of minority populations; options C and D are incorrect because these ethnic populations are not singled out in these ways.

18.You are planning an educational inservice for your nursing colleagues with the goal of fostering culturally competent care. What outcome should you prioritize when planning this education?
A)Participants will acknowledge and adapt to diversity among their colleagues.
B)Participants will develop insight into the characteristics of their own culture.
C)Participants will provide equal care to all patients, regardless of their background.
D)Participants will evaluate their colleagues’ levels of cultural awareness.
The concept of culturally competent care applies to health care institutions, which must develop culturally sensitive policies and provide a climate that fosters the provision of culturally competent care by nurses. Nurses must learn to acknowledge and adapt to diversity among their colleagues in the workplace. This is not necessarily dependent on nurses examining their own cultures. Because patients’ needs vary widely, care is not equal. Evaluating cultural awareness in others does not necessarily enhance one’s own cultural competence.

19.The nurse assessing health disparities in the community is focusing on disparities that exist apart from those between ethnic groups. In which of the following groups are these disparities most evident?
A)Urban men
B)People with disabilities
C)People who are single
D)Middle-aged adults
Health disparities are noted among women, gays and lesbians, and people with disabilities. Specific health disparities have not been found among men, the middle-aged, or single people.

20.You are performing a cultural nursing assessment of a newly admitted patient of Cuban descent. What would you include in your assessment? Select all that apply.
A)Family structure
C)Cultural beliefs
D)Health practices
Ans:A, C, D, E
Cultural nursing assessment refers to a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. Subgroups are not a specific focus of this assessment.

21.The quality improvement team at a large, urban hospital has recognized the need to better integrate the principles of transcultural nursing into patient care. When explaining the concept of transcultural nursing to uninitiated nurses, how should the team members describe it?
A)Transcultural nursing is the comparative analysis of the health benefits and risks of recognizable ethnic groups.
B)Transcultural nursing refers to research-focused practice that focuses on patient-centered, culturally, competent nursing.
C)Transcultural nursing refers to a systematic and evidence-based effort to improve health outcomes in patients born outside the United States.
D)Transcultural nursing is a term used to describe interventions that seek to address language barriers in nursing practice.
Transcultural nursing, a term sometimes used interchangeably with cross-cultural, intercultural, or multicultural nursing, refers to research-focused practice that focuses on patient-centered, culturally competent nursing. It is not limited to language barriers and foreign-born patients. It does not focus solely on health risks and benefits in ethnic groups.

22.During an orientation class, the medical unit’s nursing educator is presenting education on transcultural nursing to a group of new nursing graduates. What should the staff educator identify as the underlying focus of transcultural nursing?
A)The underlying focus of transcultural nursing is to enhance the cultural environment of institutions.
B)The underlying focus of transcultural nursing is to promote the health of communities.
C)The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care.
D)The underlying focus of transcultural nursing is to promote the well-being of discrete, marginalized groups.
The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care that promotes the well-being or health of individuals, families, groups, communities, and institutions. It is not limited to institutions, communities, or marginalized groups.

23.A hospital’s written policies and procedures are being reviewed as part of an accreditation process. Which of the following policies are congruent with the principles of culturally competent nursing care? Mark all that apply.
A)A policy that outlines the appropriate use of translation services
B)A policy guiding staff in the care of patients with different values
C)A policy that requires staff from different cultures on each unit
D)A policy that establishes flexible regulations pertaining to visitors
E)A policy that gives priority to patients born outside the United States
Ans:A, B, D
Policies that promote culturally competent care establish flexible regulations pertaining to visitors (number, frequency, and length of visits), provide translation services for non–English-speaking patients, and train staff to provide care for patients with different cultural values. Cultural competence does not depend on culturally diverse staff on every unit and it does not necessarily prioritize the interests of individuals born outside the country.

24.Giger and Davidhizar (2012) created an assessment model to guide nurses in exploring cultural phenomena that might affect nursing care. When using this model in the care of a patient who has had a transurethral prostate resection (TUPR), what area of care would be influenced most directly?
A)Transferring the patient from a stretcher to a bed
B)Documenting the patient’s vital signs and level of consciousness
C)Administering a scheduled dose of acetaminophen
D)Explaining the rationale for continuous bladder irrigation (CBI)
Giger and Davidhizar identified communication, space, time orientation, social organization, environmental control, and biologic variations as relevant phenomena. Explaining CBI requires clear communication. Transferring a patient to a bed, administering Tylenol, or documenting are nursing responsibilities that are less directly relevant to this model.

25.A 56-year-old woman who emigrated from Vietnam as an adult was admitted with a urinary tract infection, but has now developed urosepsis. The nurse is in the process of changing the patient’s plan of care accordingly. The nurse should consider what phenomenon that tends to occur in patients of all ages when they are ill?
A)Tendency to regress in language skills
B)Tendency to become more passive
C)Tendency to become more involved in care
D)Tendency to regress in age-appropriate behavior
During illness, patients of all ages tend to regress, and the regression often involves language skills. The other tendencies do not apply in this case.

26.A nurse is auditing the care of a recently discharged patient and is appraising the patient’s care in light of Leininger’s theory of Culture Care Diversity and Universality. Specifically, the nurse is looking for evidence that caregivers implemented professional actions and decisions that helped the patient achieve a beneficial or satisfying health outcome. What aspect of Leininger’s theory is the nurse addressing?
A)Cross-care accommodation
B)Culture care restructuring
C)Cultural reordering
D)Patient modification
Culture care restructuring or repatterning refers to professional actions and decisions that help patients reorder, change, or modify their lifestyles toward new, different, or more beneficial health care patterns. The other listed options are not part of Leininger’s theory.

27.A nurse is caring for a child with a diagnosis of hemophilia. The child is in need of a blood transfusion, which her family’s religious beliefs forbid. What term would best describe this religion’s beliefs and their impact on health care for this child?
B)Cultural imposition
C)Cultural taboo
D)Cultural blindness
Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. The other answers do not apply.

28.A nurse has been having a number of challenging nurse–patient interactions when providing care for a patient whose surgery was complicated by a medical error. When interacting with patients and families, of what must the nurse be cognizant?
A)Her own level of health
B)The culture of the institution
C)The need to promote acculturation
D)Her own cultural orientation
Because the nurse–patient interaction is the focal point of nursing, nurses should consider their own cultural orientation when conducting assessments of patients and their families and friends. The nurse’s health is relevant, but secondary. Similarly, the institutional culture is not a priority. Acculturation is not actively promoted by the nurse.

29.After working with a patient who has human immunodeficiency (HIV) for several weeks, the nurse has become more aware of the role of health disparities. Which of the following variables are known to underlie health disparities? Select all that apply.
B)Isolated geographic location
C)Overdependence on publicly funded facilities
D)Male gender
E)Allergy status
Ans:A, B, C
Many reasons are cited for these disparities, including low socioeconomic status, health behaviors, limited access to health care because of poverty or disability, environmental factors, and direct and indirect manifestations of discrimination. Other causes include lack of health insurance; overdependence on publicly funded facilities; and barriers to health care, such as insufficient transportation, geographic location (not enough providers in an area), cost of services, and the low numbers of minority health care providers. Male gender and a patient’s allergy status are not identified as contributors to health disparities.

30.The future of transcultural nursing care lies in finding ways to promote cultural competence in nursing students. How can this goal be best accomplished?
A)By offering multicultural health studies in nursing curricula
B)By enhancing the content of community nursing classes
C)By requiring students to care primarily for patients from other ethnic groups
D)By screening applicants according to their cultural competence
Nursing programs are exploring creative ways to promote cultural competence and humanistic care in nursing students, including offering multicultural health studies in their curricula. Enhancing the content of community nursing classes would not necessarily achieve this goal. Matching students to patients from other cultures is often impractical and applicants are not screened by their cultural competence.

31.A nurse provides care in an inner-city hospital that serves a culturally diverse population. When attempting to foster positive and therapeutic nurse–patient interactions, the nurse should recognize that these interactions are primarily dependent on what variable?
A)The knowledge of patient tendencies during illness
B)The nurse’s ability to work with a multicultural health care team
C)The ability to understand and be understood
D)Cultural diversity among the unit staff
Nurse–patient interactions, as well as communications among members of a multicultural health care team, are dependent on the ability to understand and be understood. Nurse–patient interactions are not dependent on the knowledge of patient tendencies during illness, the nurse’s ability to work with a multicultural health care team, or cultural diversity among the staff on the unit.

32.A nurse who provides care on a busy medical unit is aware that his own beliefs do not always coincide with the beliefs of patients from some cultural backgrounds. What aspects of patient care may be most influenced by diverse cultural perspectives?
A)Pharmacokinetics and pharmacodynamics
B)Monitoring fluid balance
C)Monitoring food intake
D)Obtaining informed consent
Many aspects of care may be influenced by the diverse cultural perspectives held by health care providers, patients, families, or significant others. One example is the issue of informed consent and full disclosure. The other aspects of care can also be influenced by cultural differences, but most often to a lesser degree.

33.Personal space and distance is culturally dependent and can impact nurse–patient interactions significantly. What is the best way for the nurse to interact with a patient who has a different cultural perspective on space and distance?
A)Allow the patient to adopt a position that is comfortable for him or her.
B)Realize that sitting close to the patient is an indication of warmth and caring.
C)Position yourself 10 to 12 feet from the patient to accommodate the most common cultural preferences.
D)Remember not to intrude into the personal space of the elderly.
If the patient appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the patient should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. Older adults do not share a common perspective on personal space. A distance of 10 to 12 feet is not normally necessary. Close proximity can be interpreting as being invasive by some individuals.

34.Touch, to a great degree, is culturally determined. When providing care for a patient who belongs to a Hispanic culture, which of the following may be considered inappropriate in a health care setting?
A)Grandmothers helping in the care of pediatric patients.
B)Patients asking questions of health care providers.
C)Health care information being given to a female member of the family.
D)Males participating in health care activities.
The meaning people associate with touching is culturally determined to a great degree. In some cultures (e.g., Hispanic, Arab), male health care providers may be prohibited from touching or examining certain parts of the female body. Similarly, it may be inappropriate for females to care for males. In the Hispanic culture, grandmothers often care for pediatric patients; the female of the family is often held responsible for the family’s health care and health care information. Males of the Hispanic culture generally do not participate in health care activities when a member of their family is ill. There is no prohibition against asking questions.

35.A 54-year-old African American man has presented for a follow-up appointment shortly after being diagnosed with hypertension and being placed on an angiotensin-converting enzyme (ACE) inhibitor. The nurse takes the patient’s vital signs at the beginning of the appointment and obtains a blood pressure of 177/96 mm Hg. What factor should the nurse consider in light of the patient’s sustained high blood pressure?
A)The patient’s culture may not prioritize taking a medication on a regular basis.
B)Biologic variations may be influencing the effectiveness of the medication.
C)The patient’s culture may not acknowledge “symptom-free” problems such as blood pressure.
D)The patient’s diet may be negatively affecting the effectiveness of the medication.
Biologic variations can be highly significant, particularly in the use of antihypertensives in African American patients. This is more likely than culturally mediated views on medication adherence, “symptom-free” diseases, or diet.

36.A nurse is planning the care of a 48-year-old woman who has just received a diagnosis of breast cancer. The patient has been explicit about her desire to integrate a variety of complementary therapies into her treatment regimen. What is the nurse’s primary responsibility around the use of complementary therapies?
A)To become skilled in administering as many complementary therapies as possible
B)To liaise between practitioners of complementary therapies and the medical team
C)To examine the evidence base underlying each of the patient’s chosen complementary therapies
D)To assess the patient’s use of complementary therapies in order to promote safety
Nurses must assess all patients for use of complementary therapies, be alert to the danger of herb–drug interactions or conflicting treatments, and be prepared to provide information to patients about treatments that may be harmful. However, nurses must be accepting of patients’ beliefs and right to autonomy (i.e., to control their own care). It is not the nurse’s role to be the intermediary between practitioners and the medical team or to evaluate the effectiveness of therapies. The nurse is also not responsible for becoming skilled in administering as many complementary therapies as possible.

37.Agency policies are important to achieve culturally competent care. When reviewing a hospital’s current policy framework, which of the following actions has the potential to improve the overall level of culture competence?
A)Reducing the institution’s dependence on English for communication
B)Promoting members of minority groups to higher profile positions
C)Eliminating written information from staff members’ identification badges
D)Creating greater flexibility in visiting hours
Policies that promote culturally competent care establish flexible regulations pertaining to visitors, such as the number, frequency, and length of visits. Eliminating written information from staff members’ identification badges is unnecessary and of little benefit. Cultural competence does not require a reduction in the use of English. Promoting members of minority groups to higher profile positions on the sole basis of ethnicity would be unethical.

38.A nurse is describing and demonstrating the technique for emptying a Vietnamese patient’s surgical drain, knowing that the patient will soon be discharged home with the drain in place. As the nurse is explaining, the patient laughs at times that appear unrelated to what the nurse is saying or doing. How should the nurse best understand the patient’s behavior?
A)The patient’s sense of humor is culturally mediated and may be unfamiliar to the nurse.
B)The patient may believe that she has sufficient knowledge and skill to empty the drain.
C)The patient may be unable to fully comprehend the information the nurse is trying to convey.
D)Individuals from the patient’s culture may not normally explain and demonstrate at the same time.
Inappropriate laughter can signal a lack of understanding. This is more likely than the presence of a culture-specific sense of humor in this particular context. It is unlikely that there is a prohibition against simultaneous explaining and demonstrating. Laughing is unlikely to suggest that teaching and learning are unnecessary.

39.A nurse is providing care for a female patient who is Hispanic. The care team is discussing the patient’s nutritional status and one of the nurse’s colleagues states, “I suppose we should try to get her some tacos or burritos since that’s what she’s probably used to.” How should the nurse best interpret the colleague’s statement?
A)The colleague may have stereotypical views of Hispanics.
B)The colleague is exemplifying the process of acculturation.
C)The colleague is aware of the dietary characteristics of Hispanic culture.
D)The colleague may harbor resentment against Hispanics.
Presuming that Hispanics rely on tacos and burritos likely reflects a stereotype of this culture, but is less likely to be motivated by resentment. This statement does not demonstrate acculturation. The colleague’s statement reflects a stereotype, not an accurate assessment of the patient’s diet and culture.

40.Computed tomography of a 72-year-old woman reveals lung cancer with metastasis to the liver. The patient’s son has been adamant that any “bad news” be withheld from his in order to protect her from stress, stating that this is a priority in his culture. How should the nurse and the other members of the care team best respond?
A)Explain to the son the team’s ethical obligation to inform the patient.
B)Refer the family to social work.
C)Have a nurse or physician from the patient’s culture make contact with her and her son.
D)Speak with the son to explore his rationale and attempt to reach a consensus.
Nurses must promote open dialogue and work with patients, families, physicians, and other health care providers to reach the culturally appropriate solution for the individual patient. A referral to social work is not a sufficient response and enlisting a caregiver from the same culture may not be ethical or effective.

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