A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best
... [Show More] described as:
A. Assimilation.
B. Acculturation.
C. Biculturalism.
D. Enculturation.
D. Enculturation.
Socialization into one's primary culture as a child is known as enculturation.
A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she:
A .Chose to be bicultural.
B. Adapted to and adopted the American culture.
C. Had an extremely negative experience with the American culture.
D. Gave up part of her ethnic identity in favor of the American culture.
B. Adapted to and adopted the American culture.
Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture.
To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own:
A. Motivation and commitment to caring.
B. Social, cultural, and biophysical factors.
C. Engagement in cross-cultural interactions.
D. Background, recognizing her biases and prejudices.
D. Background, recognizing her biases and prejudices.
Cultural awareness is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people.
Which of the following is required in the delivery of culturally congruent care?
A. Learning about vast cultures
B. Motivation and commitment to caring
C. Influencing treatment and care of patients
D. Acquiring specific knowledge, skills, and attitudes
D. Acquiring specific knowledge, skills, and attitudes
Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care.
A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient?
A. "What are your dietary preferences?"
B. "What time do you typically go to bed?"
C. "Do you bathe and use deodorant more than one time a week?"
D. "Do you have any health issues that we should know about?"
C. "Do you bathe and use deodorant more than one time a week?"
Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual's unique characteristics.
When action is taken on one's prejudices:
A. Discrimination occurs.
B. Delivery of culturally congruent care is ensured.
C. Effective intercultural communication develops.
D. Sufficient comparative knowledge of diverse groups is obtained.
A. Discrimination occurs.
Prejudices associate negative permanent characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs.
A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n):
A. Illness attributed to natural and biological forces.
B. Creation of the student's interpretation and descriptions of the data.
C. Influence of socioeconomic factors in morbidity and mortality.
D. Combination of naturalistic, religious, and supernatural modalities.
C. Influence of socioeconomic factors in morbidity and mortality.
Health disparity populations are populations that have a significant increased incidence or prevalence of disease or that have increased morbidity, mortality, or survival rates compared to the health status of the general population.
Culture strongly influences pain expression and need for pain medication. However, cultural pain is:
A. Not expressed verbally or physically.
B. Expressed only to others from a similar culture.
C. Usually more intense than physical pain.
D. Suffered by a patient whose valued way of life is disregarded by practitioners.
D. Suffered by a patient whose valued way of life is disregarded by practitioners.
Patients suffer cultural pain when health care providers disregard values or cultural beliefs.
Which of the following best represents the dominant values in American society on individual autonomy and self-determination?
A. Physician orders
B. Advance directive
C. Durable power of attorney
D. Court-appointed guardian
B. Advance directive
Informed consent and advance directives protect the right of the individual to know and make decisions ensuring continuity of individual autonomy and self-determination.
The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next?
A. Ask the patient how much salt he is consuming each day
B. Discuss the health implications of sodium and hypertension
C. Remind the patient that many foods such as soy sauce contain "hidden" sodium
D. Suggest some low-sodium dietary alternatives
A. Ask the patient how much salt he is consuming each day
In an Asian culture spoken messages often have little to do with their meanings. It is important for the nurse to clarify how much salt the patient is consuming in his diet.
A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is:
A. Give her a copy of the city bus schedule.
B. Call her the day before her appointment as a reminder to be on time.
C. Explore what has prevented her from being at the clinic in time for her appointment.
D. Refer her to a clinic that is closer to her home.
C. Explore what has prevented her from being at the clinic in time for her appointment
Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for ethnic groups.
A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension?
A. Ashkenazi Jew
B. Chinese American
C. African American
D. Filipino
C. African American
Certain genetic disorders are linked with specific ethnic groups such as malignant hypertension among African Americans.
A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won't have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because:
A. She won't resume sexual relations until her baby is weaned.
B. She is taking the medroxyprogesterone (Depo-Provera) shot.
C. Her husband was recently deployed to Afghanistan.
D. She has access to free condoms from the clinic.
A. She won't resume sexual relations until her baby is weaned.
In some African cultures such as in Ghana and Sierra Leone some women will not resume sexual relations with their husbands until the baby is weaned.
During their clinical post-conference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different:
A. Ethnicity.
B. Culture.
C. Heritage.
D. Religion.
B. Culture.
Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. This includes events such as birth, illness, and dying. It is the system of meanings by which people make sense of their experiences.
When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.)
A. Do you use any folk remedies?
B. Do you have a family physician?
C. Do you use a Shaman?
D. Does your family have a history of alcohol abuse?
A. Do you use any folk remedies?
B. Do you have a family physician?
C. Do you use a Shaman?
Obtain information about folk remedies and cultural healers that the patient uses. Assessment data yield information about the patient's beliefs about the illness and the meaning of the signs and symptoms.
The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. What principles would be a priority in a discussion about ethics?
A. Accountability because you as the nurse are accountable for the well-being of this patient
B. Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant
C. Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant
D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources
D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources
Accountability, respect or autonomy and ethics of care are not necessarily wrong, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement?
A. Beneficence
B. Accountability
C. Nonmaleficence
D. Respect for autonomy
C. Nonmaleficence
Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care.
A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation?
A. Fidelity
B. Beneficence
C. Nonmaleficence
D. Respect for autonomy
B. Beneficence
The immunization is a clear effort to provide benefit. Beneficence refers to "doing good." Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding health care plans.
When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain?
A. Fidelity
B. Beneficence
C. Nonmaleficence
D. Respect for autonomy
A. Fidelity
Requiring a return to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity.
What is the best example of the nurse practicing patient advocacy?
A. Seek out the nursing supervisor in conflicting procedural situations
B. Document all clinical changes in the medical record in a timely manner
C. Work to understand the law as it applies to an error in following standards of care
D. Assess the patient's point of view and prepare to articulate it
D. Assess the patient's point of view and prepare to articulate it
Seeking out the nursing supervisor, documenting clinical change in the medical record in a timely manner and working to understand the law as it applies to an error in following standards of care are not wrong; but advocacy generally refers to the nurse's ability to help speak for the patient.
Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following?
A. The value of something is determined by its usefulness to society.
B. People's values are determined by religious leaders.
C. The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far.
D. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider.
A. The value of something is determined by its usefulness to society.
Utilitarianism specifically refers to the greatest good for the greatest number of people, whereas goodness is determined primarily by usefulness. The concept is easier to apply in a community where shared values allow for agreement about a definition of usefulness.
The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following?
A. Patients
B. Relationships
C. Ethical principles
D. Code of ethics for nurses
B. Relationships
The foundation of the ethics of care is its attention to relationships, as distinguished from other more principal based philosophies.
In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable?
A. Nurses understand the principle of autonomy to guide respect for patient's self-worth.
B. Nurses have a scope of practice that encourages their presence during ethical discussions.
C. Nurses develop a relationship to the patient that is unique among all professional health care providers.
D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.
C. Nurses develop a relationship to the patient that is unique among all professional health care providers.
None of these options is wrong, but the point of the question is to build confidence and even pride in the value of the special body of knowledge that a nurse acquires about patients, the result of a unique relationship with them.
Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion?
A. Consult a professional ethicist to ensure that the steps of the process occur in full.
B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
C. Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process.
D. List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.
B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
Before proceeding with discussion about any difficult situation, just as in the nursing process, participants take time to gather all relevant information as insurance for reliability and validity during the discussion.
The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers?
A. Yes because patient privacy would not be violated as long as the patient identifiers were removed
B. Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy
C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work
D. No because the principal of justice requires you to allocate resources fairly
C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work
Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information.
When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote?
A. Yes because ethics is essentially a democratic process, with all participants sharing an equal voice
B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do
C. Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care
D. No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department
B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do
Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion.
Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas?
A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations
B. To await new clinical orders from the physician
C. To limit discussions about ethical principals
D. To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues
A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations
Nursing plays a unique and critical role in the resolution of difficult ethical situations. The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the health care team.
A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.)
A. Quality of life is measured by potential income, and average income varies in different regions of the country.
B. Community values are subject to change, and communities influence definitions of "quality."
C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult.
D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.
B. Community values are subject to change, and communities influence definitions of "quality."
C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult.
D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.
Definitions of quality depend on individual experience and value integrated into community standards, but value refers to elements beyond monetary value.
Which of the following explain how health care reform is an ethical issue? (Select all that apply.)
A. Access to care is an issue of beneficence, a fundamental principal in health care ethics.
B. Reforms promote the principle of beneficence, a hallmark of health care ethics.
C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence.
D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
B. Reforms promote the principle of beneficence, a hallmark of health care ethics.
C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence.
D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
Since health care reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Access to care is an issue of justice.
Which is the best method of negotiating or processing difficult ethical situations?
A. Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain.
B. Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes.
C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.
D. Medical experts are best able to resolve conflicts about outcome predictions.
C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.
Ethics is ultimately an activity of community, resolved successfully through institutional ethics committees and not easily resolved by deference to a single expert or leader.
The increasing number of ethnic groups in the United States has been influenced by what?
A. Communicable diseases in disadvantaged countries
B. Increasing immigration
C. Homelessness
D. Healthcare reform
B. Increasing immigration
Currently, emerging populations include ethnic minorities and persons who are homeless. Ethnic minority populations could include Asian Americans/Pacific Islanders, Blacks/African Americans, Latinos/Hispanic Americans, Native Americans, and Arab Americans. The increasing population of immigrants has been a significant contributor to the presence of increasing numbers of major ethnic groups in the United States. [Show Less]