Chapter 06: Cultural Aspects of Nursing Care
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
- A home health nurse prepares to teach a Latino patient who neither speaks nor reads English how to measure and administer insulin. Which teaching tool should be the most helpful?
| a. | Booklet from the American Diabetes Association explaining the effects of too much or too little insulin |
| b. | Nutrition pamphlet explanation discussing amounts of each food group needed each day |
| c. | Alarm clock, magazine pictures showing sunrise and sunset, several clean insulin syringes, and insulin bottles filled with colored water |
| d. | Large sheet explaining the need for washing hands, times, amounts of insulin to inject, and the nurse’s home phone number |
ANS: C
If the patient has been assessed as not being able to process written or spoken English, providing literature is futile. A nutrition pamphlet has nothing to do with injecting insulin. Pictures and a clock are universal symbols that are readily understood. Return demonstrations with the actual syringe are good learning exercises.
DIF: Cognitive Level: Application REF: p. 68 OBJ: 4
TOP: Adaptation for Cultural Diversity KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
- A young Asian wife of a businessman recently transferred to the United States is brought to the hospital for an emergency appendectomy. The nurses make every effort to plan correct care. Which term best describes the integration of cultural concepts into the nursing care plan?
| a. | Assimilation of culture |
| b. | Cultural diversity |
| c. | Enculturation of the patient |
| d. | Transcultural nursing |
ANS: D
The health team must be sensitive to an Asian patient’s preference for alternative health care measures such as herbalists and medication, as well as understand that pain is endured quietly, without complaint.
DIF: Cognitive Level: Comprehension REF: p. 67 OBJ: 1
TOP: Transcultural Nursing KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse is clearing the bedside area to give a bed bath to a Muslim woman the day after a cesarean section. What action should the culturally sensitive nurse implement?
| a. | Pick up and move the copy of the Koran so it will not be soiled with bath water. |
| b. | Ask the patient to remove the taviz to prevent it from being touched by a non-Muslim. |
| c. | Offer a quiet time after the bath for prayer. |
| d. | Be especially protective of her modesty. |
ANS: D
Muslim women are extremely modest and prefer clothes that cover the entire body. The Koran is not to be handled by any non-Muslim person, and the taviz is worn at all times. Muslim women are excused from prayer for 40 days after childbirth.
DIF: Cognitive Level: Application REF: p. 74 OBJ: 5
TOP: Assessing Cultural Influences Pertinent to Nursing Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse is caring for a young woman who is a member of the Church of Jesus Christ of Latter Day Saints (Mormon).What should be offered as an appropriate snack by the nurse?
| a. | Juice and cookies |
| b. | Tea and a piece of fruit |
| c. | Coffee and a cinnamon roll |
| d. | Cola drink and chips |
ANS: A
The Mormon faith abstains from the use of beverages with caffeine such as cola, coffee, and tea. Juice and cookies do not violate the dietary habits.
DIF: Cognitive Level: Application REF: p. 73 OBJ: 2 | 4
TOP: Dietary Habits KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
- Two licensed practical/vocational nurses (LPN/LVNs) are colleagues on the same medical-surgical floor. They went to the same LPN/LVN school. When on break time, they discuss the holistic entries of the nursing care plans they are helping create. What does this behavior exemplify?
| a. | Subculture |
| b. | Democracy |
| c. | Diversity |
| d. | Ethnicity |
ANS: A
Professional nursing is a subculture that is learned in the professional school and experienced by practitioners in practice settings, such as a hospital break room, where nurses of a similar subculture can address patient care planning issues to provide holistic nursing care.
DIF: Cognitive Level: Comprehension REF: p. 68 OBJ: 5
TOP: Subculture of Professional Nursing KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- At the request of the family, an instructor makes an assignment change for a black male student who had been assigned to take care of a postpartum Muslim woman. What is the most likely reason that the request was made by the family?
| a. | Muslim culture does not allow black practitioners to care for women. |
| b. | Muslim culture prefers that women health care providers care for Muslim women. |
| c. | The husband will be present, and he will object. |
| d. | After childbirth, all care must be performed by women. |
ANS: B
The cultural aspects of a patient must be respected. Muslims prefer female care providers for women because of the extreme modesty of Muslim women.
DIF: Cognitive Level: Comprehension REF: p. 74 OBJ: 4
TOP: Culturally Correct Health Teaching
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A severely injured man is brought into the emergency department after an automobile accident and is given two units of O-negative blood while waiting for a cross-match to be completed for the other 4 units of blood that the physician has ordered. The nurse discovers a card identifying the man as a Jehovah’s Witness. What is the most appropriate nursing action?
| a. | Inform the laboratory to hold the process on typing and crossmatching the 4 units of blood. |
| b. | Call the hospital administration to obtain a court order to intervene. |
| c. | Inform the physician that the patient is a Jehovah’s Witness. |
| d. | Remove all tourniquets and cardiac monitoring devices. |
ANS: C
Jehovah’s Witnesses do not permit the infusion of blood or blood products under any circumstances. The physician who ordered the blood transfusion must be notified immediately.
DIF: Cognitive Level: Application REF: p. 73 OBJ: 3
TOP: Cultural Beliefs of Jehovah’s Witnesses
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
- A nurse is leading a discussion with a group of residents of a Jewish long-term care facility. When discussing dietary laws and other religious practices, what should the nurse anticipate as the most prominent need of these patients?
| a. | Fasting every Friday night from sunset until sunset on the following Saturday and not taking them to the dining room |
| b. | Having a quiet time for prayer provided before and after all meals |
| c. | Serving meat and milk products at the same time but on separate plates |
| d. | Allowing Jewish men to shave before their Sabbath |
ANS: B
The Jewish religion observes a prayer ritual before and after meals. Fasting is usually done only for Yom Kippur. Meat and milk are not served together in a meal. Jewish men retain their facial hair but only cut it with scissors, not with a shaver.
DIF: Cognitive Level: Application REF: p. 69 OBJ: 2
TOP: Jewish Culture KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A Filipino man is admitting his elderly mother to a long-term care facility for custodial care. During the intake interview, the man is alternately tearful and defensive. To what Filipino belief does the culturally competent nurse assess this labile behavior as being related?
| a. | Medical facilities are a place of death. |
| b. | Families should care for the older family members at home. |
| c. | His language barrier is causing him to be misunderstood. |
| d. | Such facilities will limit visitations from the family. |
ANS: B
Filipino culture prides itself in its ability to care for their older family members in the home. Family ties are very strong, and visits by many family members are an indication of their love and concern.
DIF: Cognitive Level: Comprehension REF: p. 68 OBJ: 2
TOP: Ethnic Beliefs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A Japanese patient, hospitalized for arteriosclerotic heart disease and hypertension, is allowed to have a regular diet with cultural provisions of Asian food. A diuretic, antibiotic, bronchodilator, and vasodilator have been prescribed. Which medication would be hampered by an Asian diet?
| a. | Bronchodilator |
| b. | Vasodilator |
| c. | Diuretic |
| d. | Antibiotic |
ANS: C
The Japanese diet is rich in sodium, which may interfere with the efficacy of a diuretic medication.
DIF: Cognitive Level: Application REF: p. 80 OBJ: 1
TOP: Sodium-Rich Diet and Antihypertensive Medication
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
- A patient of Chinese descent is in the community clinic for treatment of arthritis. The patient tells the nurse that the disease is a “hot disease.” The nurse assesses that the patient is referring to the hot-cold theory. What cause is attributed to hot diseases?
| a. | Body’s reaction to hot weather |
| b. | Excessive blood and yellow bile |
| c. | Invasion of hot or evil thoughts, causing the body to react |
| d. | Overeating cold foods |
ANS: B
Persons of Chinese descent believe that disease is caused by the four humors, which get out of balance and cause a hot or cold disease. Blood and yellow bile are considered hot.
DIF: Cognitive Level: Comprehension REF: p. 75-76 OBJ: 2
TOP: Ethnicity-Related Response to Sedative Drugs
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
- A nurse has scheduled a specific time for a group of Latino patients with diabetes to come for diabetic teaching, but the group does not come until almost an hour later. What should the culturally competent nurse suspect has occurred?
| a. | The language barrier caused a miscommunication. |
| b. | Denial about the disease has delayed arrival. |
| c. | Their culture places little significance on the concept of time. |
| d. | Timely arrival is rude because it may inconvenience the hostess. |
ANS: C
Some cultures place little to no significance on formal time and appear late or not at all for appointments.
DIF: Cognitive Level: Application REF: p. 81 OBJ: 3
TOP: Cultural Use of Time Commitments
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- Transcultural nursing care is expected for every patient. To provide this type of care, the nurse needs to understand the practices of the predominant cultures of those groups in the health care geographic area. What should this require the nurse to be aware of?
| a. | Culture influences beliefs about health, illness, and health practices. |
| b. | All members of an ethnic group have the same beliefs about health practices. |
| c. | A patient’s culture rather than individual assessments can be the basis of care. |
| d. | Members of subcultures must be encouraged by nurses to adopt the dominant culture. |
ANS: A
Transcultural nursing assumes that the nurse is aware of the beliefs about health, illness, and health care practices of the individual being cared for and has added these concepts into the care planning, implementation, and evaluation of practice.
DIF: Cognitive Level: Comprehension REF: p. 67 | p. 78 OBJ: 3
TOP: Transcultural Nursing KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- After a Jewish woman has given birth and returns to her room, the husband arrives with a camera. What is the best response for the culturally sensitive nurse?
| a. | “Here is a chair near the door so you can be comfortable while you visit.” |
| b. | “I’ll give you all some privacy because I know you want to give your wife a big hug.” |
| c. | “Let me get some instructions for you to follow in her home care after she is discharged this afternoon.” |
| d. | “Sit on the bed and put your arm around your wife, and I will take your photograph.” |
ANS: A
The Jewish woman who has just given birth is considered unclean and cannot be touched by her husband until blood flow has stopped.
DIF: Cognitive Level: Application REF: p. 69 OBJ: 4
TOP: Illness Health Practices KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What should be included in a patient’s care plan in consideration of cultural similarities?
| a. | Family, educational background, and economic level should all be considered. |
| b. | Subtle communication involving languages should be considered. |
| c. | Families have strong patriarchal leaders. |
| d. | Culture is learned, shared, and expressed similarly among members. |
ANS: D
Different cultures have some similarities and some differences. How the culture is expressed in health care settings will be diverse.
DIF: Cognitive Level: Comprehension REF: p. 67 OBJ: 1
TOP: Similarities among Cultures KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care
- As breakfast trays are served, a Catholic patient asks the nurse to take it away, because a priest is coming to administer Communion. What is the best response by the nurse?
| a. | “You really need this nutrition. I have to leave it for you. Regardless, you must eat.” |
| b. | “I will leave the tray in the kitchen. You may call me to bring it back when it is time.” |
| c. | “You must eat your breakfast before it gets cold. If the priest comes, tell him to wait for you.” |
| d. | “Communion is only another piece of bread, so it will go just fine with your eggs.” |
ANS: B
Unless in danger of death, Catholics need to fast for at least 15 minutes before and require a period of quiet time after receiving Communion.
DIF: Cognitive Level: Application REF: p. 70 OBJ: 5
TOP: Catholic Communion Requirements
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse is planning the delivery of transcultural nursing care. Which is the best approach for the nurse to select?
| a. | Facility’s chaplain if anything special should be included in the care plan |
| b. | Patient if any special foods, symbols, or practices should be respected and whether they should be included in the health care plan |
| c. | Family if anything special exists in the patient’s culture or religion that should be included in care planning |
| d. | Other staff if they have ever had this type of patient before and how they modified the care plan |
ANS: B
The patient, when able, is the only person who can answer this question.
DIF: Cognitive Level: Application REF: p. 67 | p. 78 OBJ: 2
TOP: Transcultural Nursing KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse learns at report that a patient is a member of a Seventh-Day Adventist group. At mealtime, which trays should be served to this patient?
| a. | Corn flakes with whole milk, cranberry and orange juices, buttered muffin, and coffee |
| b. | Mixed salad with chunks of chicken, potato salad, orange juice, and a small apple |
| c. | Scrambled eggs and crisp bacon, melon slice, wheat toast, and hot tea |
| d. | Broiled flounder, scalloped potatoes, yellow squash, green bean salad, rice pudding, and coffee |
ANS: B
This religion forbids the eating of pork products (bacon) and drinking strong beverages such as tea and coffee.
DIF: Cognitive Level: Application REF: p. 72 OBJ: 1
TOP: Seventh-day Adventist Food Rules KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
- A practicing Hindu patient is dying but has orders for a full diet. However, the patient will accept only soups. Which is the most appropriate food for the nurse to order for this patient?
| a. | Beef broth with bits of tomatoes and potatoes |
| b. | Puréed tomatoes, carrots, celery, and potatoes in a vegetable stock |
| c. | Chicken stock with rice noodles and celery |
| d. | Finely chopped roast beef and mashed rice with vegetable broth gravy |
ANS: B
Members of certain Hindu sects are vegetarians.
DIF: Cognitive Level: Application REF: p. 74 OBJ: 1
TOP: Hindu Dietary Regulations KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
- A nursing assistant reports to the nurse, “The Hindu patient in room 4 is not responding but is breathing, and his skin is warm and dry.” What should the culturally sensitive nurse recognize as the probable cause of this behavior?
| a. | Karma |
| b. | Yoga trance |
| c. | Moksha |
| d. | Caste atonement |
ANS: B
This Hindu man is attempting to reach the highest level of meditation in Yoga, during which he may become totally unresponsive.
DIF: Cognitive Level: Comprehension REF: p. 74 OBJ: 4
TOP: Yoga Trance KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- An Orthodox Jewish patient has died at 0300 on a Wednesday, and no family member was present. What intervention should the culturally competent nurse implement before the family arrives?
| a. | Avoid touching the body until an Orthodox Jew arrives. |
| b. | Call the hospital chaplain to come and stay with the body. |
| c. | Place the patient’s copy of the Koran at the bedside. |
| d. | Wash the body and straighten up the room. |
ANS: A
Death practices of this group are very strict. However, in the absence of family, the body should not be touched. No non-Jewish person should touch the body. The Koran is the religious guide for those of the Muslim faith.
DIF: Cognitive Level: Application REF: p. 69 OBJ: 5
TOP: Death Practices of Orthodox and Conservative Jews
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What is the term for cultures and subcultures existing within the same society, as they do in the large cities of the United States?
| a. | Cultural diversity |
| b. | Cultural ethnicity |
| c. | Mixed society |
| d. | Cultural immigration |
ANS: A
The correct term for cultural groups within the society is cultural diversity.
DIF: Cognitive Level: Knowledge REF: p. 67 OBJ: 1
TOP: Cultural Diversity Definition KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care
- A nurse is aware that slow drug metabolism can cause oversedation with some tranquilizers and sedatives. What culture is this characteristic most likely to represent?
| a. | Chinese |
| b. | Indian |
| c. | Native Americans |
| d. | Latinos |
ANS: A
Recent tests have found that persons of Chinese and Japanese descent have an alteration in liver enzymes that slows the metabolism of some tranquilizers and sedatives, which results in oversedation of these drugs.
DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 3
TOP: Over Sedation KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
MULTIPLE RESPONSE
- In what alternate health care practice do Latino individuals believe? (Select all that apply.)
| a. | Use of a folk healer |
| b. | Folk remedies |
| c. | Self-mutilation |
| d. | Sweating in a smoke tent |
| e. | Use of peyote |
ANS: A, B
Using folk healers (curanderos or curanderas) and folk remedies are components of the Latino culture. Self-mutilation, sweating, and using peyote are associated more with the American Indian culture.
DIF: Cognitive Level: Knowledge REF: p. 76 OBJ: 1
TOP: Alternate Treatment Options KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
COMPLETION
- The process in which children mature and take on the values of their families and their society is called _____.
ANS:
enculturation
Enculturation is the process of learning to be part of a culture.
DIF: Cognitive Level: Comprehension REF: p. 68 OBJ: 1
TOP: Enculturation KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The Asian theory of hot and cold as a source of illness is based on the imbalance of the four _____.
ANS:
humors
The four humors (phlegm, blood, black bile, and yellow bile) are believed to regulate the body functions.
DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 1
TOP: Hot and Cold Theory of Illness KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A nurse explains that a Hindu refers to the record of his or her life and its accomplishments as _____.
ANS:
karma
Karma is the term used by a Hindu to reflect his life’s experiences.
DIF: Cognitive Level: Comprehension REF: p. 74 OBJ: 2
TOP: Karma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
Chapter 07: The Nurse and the Family
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
- What is the primary reason that family is an important unit in society?
| a. | Offers unconditional love and acceptance |
| b. | Provides emotional support and security |
| c. | Is essential to life and society |
| d. | Promotes cultural values and attitudes |
ANS: B
A family is defined as being joined together by bonds of sharing and emotional closeness.
DIF: Cognitive Level: Comprehension REF: p. 83 OBJ: 1
TOP: The Family Unit KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- What should a nurse assess when a patient comes from an extended family?
| a. | Multiple wage earners |
| b. | Three generations living together |
| c. | Children from previous marriages |
| d. | Parents of different ethnic origins |
ANS: B
The extended family consists of relatives of either spouse who live with the nuclear family. Children, regardless of their parentage, are considered part of the nuclear family.
DIF: Cognitive Level: Comprehension REF: p. 83 OBJ: 2
TOP: Types of Families KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
- What type of families is most prevalent in the United States according to the latest Census Bureau report?
| a. | Nontraditional |
| b. | Blended |
| c. | Multigenerational |
| d. | Traditional |
ANS: D
Nearly 50% of families live in a traditional family setting according to the2010 Census Bureau report.
DIF: Cognitive Level: Knowledge REF: p. 83 OBJ: 2
TOP: Family Settings KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- In what type of family are children of racial minorities most likely to belong?
| a. | Blended |
| b. | Extended |
| c. | Traditional |
| d. | Nontraditional |
ANS: B
Census Bureau findings from 2000 indicate that children of racial minorities are twice as likely as white children to live in extended families.
DIF: Cognitive Level: Knowledge REF: p. 83 OBJ: 2
TOP: Family Settings KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A nurse is designing a home care plan for a child with a congenital disease and is assessing the family values regarding home care. What is the best resource for the nurse to use?
| a. | Current literature on congenital deformities |
| b. | General knowledge of the culture |
| c. | Patient’s family |
| d. | Written survey |
ANS: C
Determining the family’s values, beliefs, customs, and behaviors that influence health needs and health care practice is important. The best source is the family itself.
DIF: Cognitive Level: Comprehension REF: p. 84 OBJ: 2
TOP: Cultural Aspects KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse counsels a family regarding the stage of families with adolescents. Which developmental task is appropriate for the nurse to include?
| a. | Maintaining relationships with the extended family |
| b. | Developing parental roles to meet the needs of children |
| c. | Maintaining a satisfying marital relationship |
| d. | Maintaining open communication between parent and children |
ANS: D
The family developmental tasks at this stage include balancing freedom with responsibility and maintaining communication between parents and children.
DIF: Cognitive Level: Comprehension REF: p. 84 | p. 88 OBJ: 3
TOP: Family Life Cycles KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
- Which developmental task should families master in later life?
| a. | Becoming role models for their grandchildren |
| b. | Making a significant contribution to society |
| c. | Abandoning the parental role to grown children |
| d. | Maintaining a satisfactory living arrangement |
ANS: D
The last stage of the family life cycle includes families in later life who are adjusting to retirement, the aging process, decreased self-esteem, and changes in status and health issues. Maintaining a satisfactory living arrangement is the primary developmental task.
DIF: Cognitive Level: Comprehension REF: p. 85 OBJ: 3
TOP: Family Life Cycles KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
- Culture and social class usually set a precedent for different roles and responsibilities of each family member. Which example best demonstrates the healthiest family?
| a. | The father assumes the role as breadwinner. |
| b. | The mother assumes the role as homemaker. |
| c. | The father or mother shares the roles of breadwinner and homemaker. |
| d. | The roles of breadwinner or homemaker can be shifted as needed. |
ANS: D
A healthy family is one in which the opportunity to shift roles occurs easily from time to time.
DIF: Cognitive Level: Comprehension REF: p. 85 OBJ: 2
TOP: Family Role Structure KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- During a family counseling session, a patient, a mother of a 5-year-old son, states, “I don’t understand why my husband continually tries to get our son involved in T-ball. My son said the coach and his dad yelled at him and told him the game was lost because he couldn’t catch the ball.” What is the most important family interaction to maintain a healthy family unit?
| a. | Maintain open communication among all family members. |
| b. | Encourage self-acceptance and self-esteem for all family members. |
| c. | Encourage all family members to participate in community events. |
| d. | Realize that not all family members may be able to fulfill assigned roles. |
ANS: B
The most important influence on family interaction is the self-esteem of each member.
DIF: Cognitive Level: Comprehension REF: p. 86 OBJ: 4
TOP: Family Interaction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
- For the past three evenings, shortly after their arrival in the hospital unit, the parents of a 14-year-old daughter begin to argue about the cost of the hospitalization and the time required to come to the hospital. The patient begins to cry and complains about her abdominal pain. What role is the patient assuming?
| a. | Caretaker |
| b. | Martyr |
| c. | Blocker |
| d. | Scapegoat |
ANS: D
A scapegoat usually assumes the role to maintain homeostasis, serving to divert attention from marital conflict between spouses.
DIF: Cognitive Level: Analysis REF: p. 86 OBJ: 4
TOP: Family Role Structure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A patient, a 36-year-old mother of four children, is crying. She relates to you that her best friend just told her, “You are a good mother and you do everything perfectly, but I don’t think you enjoy it.” What role is the patient assuming?
| a. | Caretaker |
| b. | Martyr |
| c. | Contributor |
| d. | Harmonizer |
ANS: B
A martyr sacrifices everything for the sake of the family.
DIF: Cognitive Level: Analysis REF: p. 86 OBJ: 4
TOP: Family Role Structure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What is the basis for the roles children assume in families?
| a. | Obligation |
| b. | Instinct |
| c. | Observation |
| d. | Rewards |
ANS: D
Parents reward children for fulfilling certain roles, which children adopt and maintain as they mature.
DIF: Cognitive Level: Comprehension REF: p. 86 OBJ: 4
TOP: Family Role Structure KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
- A patient confides that her husband shares only the incidental happenings of his day at work as he reads the paper, and he never tells her that he loves her anymore. She is beginning to wonder if their marriage is getting stale. What communication pattern should the nurse recognize?
| a. | Affective |
| b. | Affectional |
| c. | Functional |
| d. | Dysfunctional |
ANS: D
One type of dysfunctional communication involves using chitchat about unimportant daily occurrences to avoid discussing meaningful issues or expressing feelings.
DIF: Cognitive Level: Analysis REF: p. 87 OBJ: 4
TOP: Functional Communication KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What should a nurse consider when discussing the communication patterns of families with the patient?
| a. | Cultural aspects of the family |
| b. | Age of the family members |
| c. | Role adopted by each family member |
| d. | Number of members in the family |
ANS: A
Although each option has significance, cultural aspects must be considered in determining the functioning level of the family as it affects the roles taken.
DIF: Cognitive Level: Comprehension REF: p. 87 OBJ: 4
TOP: Functional Communication KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A patient states that her 5-year-old daughter is always running up to relatives and friends and wants to give them a big hug and kiss. The patient asks if her daughter is appropriate in her actions. What is the most appropriate reply based on the concepts of functional communication?
| a. | “Your daughter’s actions are definitely dysfunctional.” |
| b. | “Your daughter is just being a ‘little girl’ and will outgrow being so affectionate.” |
| c. | “Your daughter is going through a normal developmental phase.” |
| d. | “Does your mother-in-law show signs of affection toward your daughter?” |
ANS: C
Physical expression of emotion usually dominates in early childhood and is normal in the developmental pattern.
DIF: Cognitive Level: Application REF: p. 86-87 OBJ: 4
TOP: Functional Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
- For what should functional patterns of communication in the family setting provide a means?
| a. | Nurturing |
| b. | Information |
| c. | Closeness |
| d. | Openness |
ANS: A
Functional patterns of communication include emotional and affective communication that deals with the expression of feelings and nurturing. A healthy family is able to demonstrate a wide range of emotions and feelings.
DIF: Cognitive Level: Comprehension REF: p. 86-87 OBJ: 4
TOP: Functional Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What does the manner in which a family unit adapts to stress affect?
| a. | Ability to communicate and function |
| b. | Health and function |
| c. | Level of affective communication |
| d. | Ability to adapt and function |
ANS: B
The manner in which a family handles stress can affect the health of the family.
DIF: Cognitive Level: Comprehension REF: p. 87 OBJ: 5
TOP: Stress and Adaptation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A patient who was recently diagnosed with cancer tells the nurse that she is so grateful for her children and family because she does not know what she would do without them. Which coping response is being exhibited?
| a. | Internal family |
| b. | External family |
| c. | Family communication |
| d. | Social support |
ANS: A
The internal family coping responses are those that the family relationships use as support.
DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 5
TOP: Coping Strategies KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What is the main role of the nurse when assessing families and their coping strategies?
| a. | Emotional support and reassurance |
| b. | Information and reassurance |
| c. | Emotional support and referral |
| d. | Elimination of the stressor |
ANS: B
Families need information and reassurance.
DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 6
TOP: Role of the Nurse KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A patient who is recovering from a mastectomy relates that she no longer feels like a woman. What is the best response by the nurse?
| a. | “I am sure you will feel differently when you have your prosthetic bra.” |
| b. | “Have you told your husband how you feel?” |
| c. | “I will bring you a catalog that carries built-in prosthetic bras.” |
| d. | “Would you like me to arrange a visit from ‘Reach for Recovery’?” |
ANS: D
Information through organizations can help a patient learn about what to expect, the disease process, and the recovery.
DIF: Cognitive Level: Application REF: p. 88-89 OBJ: 6 | 7
TOP: Community Resources KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A patient states that her mother has just been diagnosed with Alzheimer disease and that she is devastated and does not know what to do. The nurse suggests that she attend a support group meeting where she can discuss her concerns with others. The patient says that she will call and attend a meeting. Which coping strategy is the patient using?
| a. | Internal family coping by sharing feelings |
| b. | External family coping by seeking information |
| c. | External family coping by seeking social support |
| d. | Internal family coping to maintain a cohesive family unit |
ANS: C
Coping responses include internal and external family coping responses. External coping strategies refer to the use of social support systems to solve problems.
DIF: Cognitive Level: Comprehension REF: p. 88-89 OBJ: 5
TOP: Coping Strategies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What is a nursing priority when assessing the coping measures of families under stress?
| a. | Determine the type of coping mechanisms used by the family in the past. |
| b. | Consider the relationship of the family members. |
| c. | Relieve the anxiety and fear of the family members. |
| d. | Determine what stressors the family is currently experiencing. |
ANS: D
Family coping strategies are actions that families use to respond to stressors.
DIF: Cognitive Level: Application REF: p. 87-88 OBJ: 5
TOP: Coping Mechanisms KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- As a nurse is preparing a patient for a colonoscopy, the patient states that she is nervous about the procedure but knows it will help her physician diagnose her problem. Which coping strategy should the nurse recognize the patient is using?
| a. | Internal family coping by interpreting events in a positive manner |
| b. | Internal family coping by relieving anxiety and tension with humor |
| c. | External family coping by seeking social support |
| d. | External family coping by depersonalizing the procedure |
ANS: A
Coping strategies include interpreting the events in a positive way.
DIF: Cognitive Level: Analysis REF: p. 87-88 OBJ: 5
TOP: Coping Strategies KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What is the best description of the current view of the family as a unit?
| a. | Functioning together to provide security and support to its members |
| b. | Functioning to meet the needs of society and support its members |
| c. | A unit of two or more that shares common goals and mutual support |
| d. | A unit of two or more joined together by mutual bonds and identity |
ANS: D
Friedman (1997) defined the family as “. . . two or more persons joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family.”
DIF: Cognitive Level: Comprehension REF: p. 83 OBJ: 1
TOP: Family Role Structure KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A nurse reminds a patient that communication in the family unit involves continual exchange of information. Which is the best example of this concept?
| a. | Determining the intent of the communication being sent |
| b. | Determining whether the communication is functional or dysfunctional |
| c. | Accepting individual differences |
| d. | Excluding emotional responses |
ANS: C
Clear communication is a way of fostering a nurturing environment. Communication patterns in a functional family demonstrate an acceptance of individual differences, openness, honesty, and recognition of needs.
DIF: Cognitive Level: Comprehension REF: p. 86 OBJ: 4
TOP: Family Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
MULTIPLE RESPONSE
- What is included in the functional communication styles in a family? (Select all that apply.)
| a. | Openness |
| b. | Subtlety |
| c. | Chitchat |
| d. | Spontaneity |
| e. | Self-disclosure |
ANS: A, D, E
Functional communication is open and honest and has no subtlety or superficial chitchat.
DIF: Cognitive Level: Comprehension REF: p. 87 OBJ: 4
TOP: Functional Communication KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- A nurse makes a patient referral to a community resource. What benefit(s) will this referral provide? (Select all that apply.)
| a. | Provision of helpful literature |
| b. | Ongoing and consistent assistance |
| c. | Reassurance to the family members that they are not alone |
| d. | A variety of free services |
| e. | Organization of a support group |
ANS: A, B, C, E
Community resources can provide assistance, literature, and support in an ongoing and consistent manner, but the services are not always free.
DIF: Cognitive Level: Comprehension REF: p. 88 OBJ: 7
TOP: Community Resources KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
COMPLETION
- A nurse congratulates a patient for successfully coping with a family crisis. The state of having used coping strategies effectively is classified as _____.
ANS:
mastery
Mastery is attained when coping skills are successful in coping with a crisis.
DIF: Cognitive Level: Comprehension REF: p. 87 OBJ: 5
TOP: Mastery KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- The nurse includes the family in patient care to maintain the family’s _____.
ANS:
self-esteem
Self-esteem is supported and maintained when family is given opportunity to contribute to the planning of patient care.
DIF: Cognitive Level: Comprehension REF: p. 86 OBJ: 5
TOP: Maintenance of Self-Esteem KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
