Balzer Riley: Communication in Nursing, 7th Edition
Chapter 04: Understanding Each Other: Communication and Culture
MULTIPLE CHOICE
1.A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? A.Discover cultural influences on health care perceptions and behaviors.
B.Assist the patients to adapt to American culture and health beliefs.
C.Avoid confrontation of underlying issues of discrimination.
D.Improve communication by learning how to speak Spanish.
ANS:A
Nurses need to know about culture because it influences both nurses’ and clients’ health care perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health. DIF:Application
TOP:Integrated Process: Caring
MSC:Psychosocial Integrity
REF:p. 48
2.The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about
delivering care to diverse clients?
A.Adopt a transcultural framework to develop culturally appropriate care.
B.Ask clients about their personal health care beliefs.
C.Develop a self-awareness of personal health care beliefs.
D.Recognize ethnocentric beliefs of minorities in the community.
ANS:C
The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal health care beliefs and behaviors. Self-awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses’ lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their health care beliefs and behaviors.
DIF:Application
TOP:Integrated Process: Caring
MSC:Psychosocial Integrity
REF:p. 49
3.The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client?
A.Review the predominant health beliefs of the Nigerian population.
B.Appraise the client’s health beliefs and behaviors with a cultural assessment.
C.Consult with other nurses who have taken care of clients from other countries.
D.Use standard communication techniques to establish a helping relationship.
ANS:B
Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client’s health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, standards) is not specific to this client’s health beliefs and behaviors.
DIF:Application
TOP:Integrated Process: CaringBalzer Riley MSC:Psychosocial Integrity
REF:p. 49
4.The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best?
A.Ask a bilingual friend of the patient to interpret.
B.Use nonverbal communication and draw pictures.
C.Request a Spanish-speaking medical interpreter.
D.Interview the patient’s English-speaking daughter.
ANS:C
Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available. DIF:Application
TOP:Integrated Process: Communication and Documentation
MSC:Psychosocial Integrity
REF:p. 51
5.The nurse is interviewing a Native American client. It is most important for the nurse to take which action?
A.Maintain eye contact to show respect and interest.
B.Assess whether the client is comfortable with eye contact.
C.Avoid prolonged eye contact with this client.
D.Sit next to the patient to avoid any eye contact.
ANS:B
Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact. DIF:Application
TOP:Integrated Process: Communication and Documentation
MSC:Psychosocial Integrity
REF:p. 53
6.The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate?
A.Use both first and last name with each encounter.
B.Ask the patient how he prefers to be addressed. C.Call the patient by his first name.
D.Address the patient by his last name.
ANS:B
It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed, because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect. DIF:Application
TOP:Integrated Process: Communication and Documentation
MSC:Psychosocial Integrity
REF:p. 54
7.The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse?
A.“I will help you remember where your room is located.”
B.“Would you like me to read from your Bible today?”
C.“Tell me a story about when you were young.”
D.“Sweetie, I will bring your coffee in a few minutes.”
ANS:D
The elderly should not be addressed using disrespectful terms such as “honey,” “sweetheart,” “gramps,” and “granny” and other patronizing forms of speech. Short term memory may decline with age; health care providers may assist patients as needed. The Balzer Riley elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning. DIF:Application
TOP:Integrated Process: Communication and Documentation
MSC:Psychosocial Integrity
REF:p. 54
8.A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective?
A.Assume a subservient role to the physician. B.Use a direct approach with succinct sentences. C.Ask questions instead of making recommendations.
D.Be polite and expect politeness from the physician.
ANS:B
Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role
to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise. DIF:Analysis
TOP:Integrated Process: Communication and Documentation
MSC:Safe and Effective Care Environment: Management of Care
REF:p. 56
9.Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse?
A.19-year-old white female patient who is standing two feet in front of the nurse. B.40-year-old African-American male patient who is sitting next to the nurse.
C.60-year-old Latin-American female patient who is seated across from the nurse.
D.82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.
ANS:A
Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting, or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.
DIF:Analysis
TOP:Integrated Process: Communication and Documentation
MSC:Psychosocial Integrity
REF:p. 53
MULTIPLE RESPONSE
10.Which characteristic would the nurse use to define culture? Select all that apply.
A.Learned and shared lifeways of a particular group.
B.Social identity influenced by language and religion.
C.Belief in superiority of one’s own ethnic group.
D.Values influence both thinking and actions.
E.Several generations share the same beliefs.
ANS:A, D, E
Culture is the learned and shared beliefs, values, and lifeways of a particular group that are generally transmitted intergenerationally and influence one’s thinking and actions. Ethnicity refers to the social identity and origins of a social group due largely to language, religion, and national origin. Ethnocentrism is the universal tendency of people to believe that one’s own race or ethnic group is the most important and/or that
some or all aspects of its culture are superior to those of other groups.
DIF:KnowledgeBalzer Riley TOP:Integrated Process: Caring
MSC:Psychosocial Integrity
REF:p. 46
Chapter 07: Warmth
Test Bank MULTIPLE CHOICE
1.The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern?
A.Use a soft and relaxed tone of voice when speaking. B.Maintain a distance of 4 to 6 feet from the patient.
C.Avoid attentive behaviors when interacting with the patient. D.Engage in a verbal exchange without physical contact.
ANS:A
A soft, modulated tone of voice conveys warmth; warmth is also conveyed with relaxed, rhythmic speech. The spatial distance between the nurse and the patient can affect the perception of warmth; a comfortable, social distance for Americans is an arm’s length to 4 feet. Touching (e.g., brief pat on the shoulder, embracing hug, or extended hand) is another way to transmit warmth. A
relaxed person conveys warmth. The nurse communicates warmth when there is a genuine interest and attentiveness in the interaction with the patient.
DIF:Application
TOP:Integrated Process: Caring
MSC:Psychosocial Integrity
REF:p. 87
2.It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient?
A.20-year-old patient who is angry and throwing objects
B.32-year-old patient who is withdrawn and refuses nursing care
C.48-year-old patient who is extremely anxious about surgery
D.56-year-old patient who has a history of violent behavior
ANS:A
When the nurse feels hurt, bitter, irritated, or enraged with a patient, trying to convey warmth would be insincere. It would be appropriate to express warmth to patients who are withdrawn and anxious. Expression of warmth is appropriate for a patient with a history of violence; the patient is not exhibiting the violent behavior at this time.
DIF:Analysis
TOP:Integrated Process: Caring
MSC:Psychosocial Integrity
REF:p. 88
3.A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response
by the nurse manager’s colleague is best?
A.“Be sensitive, show respect, and be genuine.”
B.“You need to be consistently nice to the staff nurses.”
C.“Work as a staff nurse every month to develop empathy.”
D.“Staff nurses need a leader who is not emotional.”
ANS:A
Improved communication with colleagues can be enhanced by expression of warmth. Warmth enhances closeness, creates a better
work environment, and makes a colleague more approachable. A nurse manager needs to avoid insensitivity to coworkers and demonstrating aloofness and arrogance. Warmth, respect, genuineness, and empathy are needed to improve communication with colleagues. Being nice is not equivalent to expressing warmth. Empathy is not learned by performing the job of a colleague. Expression of warmth is an emotion. DIF:AnalysisBalzer Riley
