Exam (elaborations)
Chapter 14. Diversity in Health and Illness
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- West Virginia School Of Osteopathic Medicine
Chapter 14. Diversity in Health and Illness
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Chapter 14: Diversity in Health and IllnessMULTIPLE CHOICE
1. The nurse practicing in a diverse society can consider culture to be
a. a society or group that existed in a specific period of time.
b. a learned systems of beliefs, customs, language, and rituals.
c. practices or behaviors associated with specific racial groups.
d. transgenerational world views shared by diverse groups.
ANS: B
The key element of culture is that it is learned. Culture encompasses many elements, including
language, practices, habits, beliefs, rituals, and customs, all of which are socially inherited.
Cultures are historically defined by time period. For instance, the ancient Mayan people are
considered a culture that existed in a specified period of time. But this definition is not
relevant to a nurse practicing today.
Culture can include members who have different racial backgrounds.
There is a transgenerational element to culture, but diverse groups would not share their
beliefs. Each group would have its own unique beliefs.
DIF: Cognitive Level: Understand REF: 256
TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: Psychosocial Integrity
2. A nurse is working with a third-generation Iraqi American and is frustrated that the patient
continues to rely on folk healing practices and neglects to take prescribed medication. Another
nurse explains that this most likely reflects
a. a lack of understanding on the patient’s part about treatment.
b. mistrust of the health system by members of this community.
c. poor language skills despite the patient’s third-generation status.
d. the effect of transgenerational transmission of cultural beliefs.
ANS: D
Culture can transcend generations, which means that cultural beliefs can be transmitted from
generation to generation, and this is a strong possible reason for the patient’s adherence to
traditional Iraqi cultural practices.
A lack of understanding certainly could be a cause of not adhering to treatment for any
patient, but the fact that the patient is from a different cultural group and is using folk
practices should lead the nurses away from thinking this might be a primary cause.
Members of minority communities sometimes do have a lack of trust in the formalized health
care system in this country. However, this group probably does not have a sentinel event that
would lead them to mistrust the health care system en mass.
The patient is a third-generation American, which means his or her grandparents were the
immigrants. Language skills should be good within this patient’s generational group, who
were educated in American schools.
DIF: Cognitive Level: Understand REF: 256
TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: Psychosocial Integrity
, 3. A patient has a serious illness but does not seem to be responding as the nurse expects. Which
action by the nurse would most likely lead to a better understanding of this situation?
a. Ask the patient to describe what is wrong with him or her.
b. Determine whether any factors are interfering with learning.
c. Find out why the patient thinks the illness is not serious.
d. Inquire about cultural beliefs regarding health and illness.
ANS: D
Culture has a huge impact on our understanding of what constitutes health and illness. The
nurse should inquire into the meaning these constructs have for the patient in light of cultural
variation.
Asking the patient to describe what is wrong is a good place to start, but the nurse should not
limit the investigation of the situation to such a narrow perspective.
There might indeed be factors that are inhibiting the patient’s ability to learn information, but
this approach is too narrow in focus and leaves out consideration of other influences.
The question does not state that the patient does not think the illness is serious; the question
relates that the patient is responding in an unexpected way. This answer makes an assumption
that has not been verified or even investigated.
DIF: Cognitive Level: Apply TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs: Psychosocial Integrity
4. A nurse is caring for a female patient from an unfamiliar culture. The nurse has planned
extensive discharge teaching, but the patient seems uninterested, deferring all questions to an
older adult male relative. The best action by the nurse is to
a. ask the male relative to assist with discharge teaching.
b. include the male relative and revise the teaching plan.
c. remind the patient that her condition is confidential.
d. try to do the teaching when the male relative is absent.
ANS: B
For many cultures, the nurse must recognize the importance of family (or others) in health
care decision making and in health care behavior. The nurse should reconsider the discharge
teaching plan and include the male relative in creating a new one. This demonstrates
sensitivity by following the patient’s cultural cues.
The relative may not have the expertise or skill to actually assist with the teaching. Plus,
without including him when planning the teaching, the patient has a high risk of not following
through with the plan.
Confidentiality is an important concept in health care, but as nurses work with patients from
increasingly diverse cultures, the implementation of confidentiality may need revision. This
patient clearly wants her male relative included in her health care, and the nurse should follow
the patient’s lead.
Trying to teach the patient when the relative is absent will most likely create a conflict
between patient and nurse with the end result being “noncompliance” on the patient’s part.
The nurse needs to follow the patient’s cultural cues and include the relative.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: Psychosocial Integrity
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