(Test Bank) A&E 1 Comprehensive Test Bank

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A&E I Comprehensive TestbankTable of Contents Week 1 Care of Older Adults: Culture, Spirituality, Communication, Sexuality, Infection Control Chronic Illness and Older Adults__________________________________________________3 Cultural Awareness____________________________________________________________10 Older Adult__________________________________________________________________18 Communication_______________________________________________________________28 Patient Education_____________________________________________________________39 Infection Prevention and Control_________________________________________________51 Sexuality____________________________________________________________________69 Spiritual Health______________________________________________________________78 Week 2 Critical Thinking, The Nursing Process, Loss, Death, and Grief Critical Thinking in Nursing Practice_____________________________________________86 Nursing Assessment___________________________________________________________94 Nursing Diagnosis___________________________________________________________102 Planning Nursing Care________________________________________________________110 Implementing Nursing Care____________________________________________________119 Evaluation__________________________________________________________________128 The Experience of Loss, Death and Grief__________________________________________136 Week 3 Safety and Fall Prevention among Older Adults, Preventing Complications of Immobility Patient Safety and Quality_____________________________________________________146 Immobility__________________________________________________________________163 Activity and Exercise__________________________________________________________181 Week 4 Skin and Wound Care Hygiene, Introduction to Pharmacology and Medication Administration Medication Administration_____________________________________________________194 Hygiene____________________________________________________________________212 Skin Integrity and Wound Care__________________________________________________231 Week 5 Fluid & Electrolytes, Dehydration Fluid, Electrolyte and Acid-Base Balance_________________________________________251 Week 6 Pain and Sleep 1A&E I Comprehensive TestbankPain Management____________________________________________________________268 Sleep______________________________________________________________________280 Week 7 Concepts related to Oxygenation, Circulation, and Tissue Perfusion, Chronic Obstructive Pulmonary Disease Oxygenation________________________________________________________________295 Obstructive Pulmonary Diseases________________________________________________314 Week 8 Diabetes Mellitus Diabetes Mellitus____________________________________________________________331 Week 9 Hypertension, Stroke Hypertension________________________________________________________________341 Stroke_____________________________________________________________________356 Week 10 Documentation and Informatics Documentation and Informatics______________________________________368 Week 11 Nutrition, Dysphagia_____________________________________382 Week 12 Care of the Surgical Patient________________________________398 Week 1 Care of Older Adults: Culture, Spirituality, Communication, Sexuality, Infection Control Chapter 05: Chronic Illness and Older Adults Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. When caring for an older patient with hypertension who has been hospitalized after a transient ischemic (TIA), which topic is the most important for the nurse to include in the discharge teaching? a)Effect of atherosclerosis on blood vessels b)Mechanism of action of anticoagulant drug therapy c)Symptoms indicating that the patient should contact the health care provider d)Impact of the patient’s family history on likelihood of developing a serious stroke ANS: C One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The patient 2A&E I Comprehensive Testbankneeds instruction on recognition of symptoms of hypertension and TIA and appropriate actions to take if these symptoms occur. The other information may also be included in patient teaching but is not as essential in the patient’s self-management of the illness. 2. The nurse performs a comprehensive assessment of an older patient who is considering admission to an assisted living facility. Which question is the most important for the nurse to ask? a)“Have you had any recent infections?” b)“How frequently do you see a doctor?” c)“Do you have a history of heart disease?” d)“Are you able to prepare your own meals?” ANS: D The patient’s functional abilities, rather than the presence of an acute or chronic illness, are more useful in determining how well the patient might adapt to an assisted living situation. The other questions will also provide helpful information but are not as useful in providing a basis for determining patient needs or for developing interventions for the older patient. 3. An alert older patient who takes multiple medications for chronic cardiac and pulmonary diseases lives with a daughter who works during the day. During a clinic visit, the patient verbalizes to the nurse that she has a strained relationship with her daughter and does not enjoy being alone all day. Which nursing diagnosis should the nurse assign as the priority for this patient? a)Social isolation related to fatigue b)Risk for injury related to drug interactions c)Caregiver role strain related to family employment schedule d)Compromised family coping related to the patient’s care needs ANS: B The patient’s age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. Problems with social isolation, caregiver role strain, or compromised family coping are not physiologic priorities. Drug–drug interactions could cause the most harm to the patient and are therefore the priority. 4. Which method should the nurse use to gather the most complete assessment of an older patient? a)Review the patient’s health record for previous assessments. b)Use a geriatric assessment instrument to evaluate the patient. c)Ask the patient to write down medical problems and medications. d)Interview both the patient and the primary caregiver for the patient. 3A&E I Comprehensive TestbankANS: B The most complete information about the patient will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the medical record, interviews with the patient and caregiver, and written information by the patient are all included in a comprehensive geriatric assessment. 5. Which intervention should the nurse implement to provide optimal care for an older patient who is hospitalized with pneumonia? a)Plan for transfer to a long-term care facility. b)Minimize activity level during hospitalization. c)Consider the preadmission functional abilities. d)Use an approved standardized geriatric nursing care plan. ANS: C The plan of care for older adults should be individualized and based on the patient’s current functional abilities. A standardized geriatric nursing care plan will not address individual patient needs and strengths. A patient’s need for discharge to a long-term care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process. 6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should the nurse plan to implement to meet this patient’s needs? a)Suggest that the patient move closer to health care providers. b)Obtain extra medications for the patient to last for 4 to 6 months. c)Ensure transportation to appointments with the health care provider. d)Assess the patient for chronic diseases that are unique to rural areas. ANS: C Transportation can be a barrier to accessing health services in rural areas. The patient living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area. There are no chronic diseases unique to rural areas. Because medications may change, the nurse should help the patient plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications. 7. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in an older adult? a)Teach the patient to have all prescriptions filled at the same pharmacy. b)Make a schedule for the patient as a reminder of when to take each medication. c)Instruct the patient to avoid taking over-the-counter (OTC) medications or supplements. d)Ask the patient to bring all medications, supplements, and herbs to each appointment. 4A&E I Comprehensive TestbankANS: D The most information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent drug–drug interactions. Use of a medication schedule will help the patient take medications as scheduled, but will not prevent drug–drug interactions. 8. A patient who has just moved to a long-term care facility has a nursing diagnosis of relocation stress syndrome. Which action should the nurse include in the plan of care? a)Remind the patient that making changes is usually stressful. b)Discuss the reason for the move to the facility with the patient. c)Restrict family visits until the patient is accustomed to the facility. d)Have staff members write notes welcoming the patient to the facility. ANS: D TestBankWorld.org Having staff members write notes will make the patient feel more welcome and comfortable at the long-term care facility. Discussing the reason for the move and reminding the patient that change is usually stressful will not decrease the patient’s stress about the move. Family member visits will decrease the patient’s sense of stress about the relocation. 9. An older patient complains of having “no energy” and feeling increasingly weak. The patient has had a 12-lb weight loss over the past year. Which action should the nurse take initially? a)Ask the patient about daily dietary intake. b)Schedule regular range-of-motion exercise. c)Discuss long-term care placement with the patient. d)Describe normal changes associated with aging to the patient. ANS: A In a frail older patient, nutrition is frequently compromised, and the nurse’s initial action should be to assess the patient’s nutritional status. Active range of motion may be helpful in improving the patient’s strength and endurance, but nutritional assessment is the priority because the patient has had a significant weight loss. The patient may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The patient’s assessment data are not consistent with normal changes associated with aging. 10. The nurse is admitting an acutely ill, older patient to the hospital. Which action should the nurse take? a)Speak slowly and loudly while facing the patient. b)Obtain a detailed medical history from the patient. 5A&E I Comprehensive Testbankc)Perform the physical assessment before interviewing the patient. d)Ask a family member to go home and retrieve the patient’s cane. ANS: C When a patient is acutely ill, the physical assessment should be accomplished first to detect any physiologic changes that require immediate action. Not all older patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To avoid tiring the patient, much of the medical history can be obtained from medical records. After the initial physical assessment to determine the patient’s current condition, then the nurse could ask someone to obtain any assistive devices for the patient if applicable. 11. The nurse cares for an alert, homeless older adult patient who was admitted to the hospital with a chronic foot infection. Which intervention is the most appropriate for the nurse to include in the discharge plan for this patient? a)Teach the patient how to assess and care for the foot infection. b)Refer the patient to social services for assessment of resources. c)Schedule the patient to return to outpatient services for foot care. d)Give the patient written information about shelters and meal sites. ANS: B An interprofessional approach, including social services, is needed when caring for homeless older adults. Even with appropriate teaching, a homeless individual may not be able to maintain adequate foot care because of a lack of supplies or a suitable place to accomplish care. Older homeless individuals are less likely to use shelters or meal sites. A homeless person may fail to keep appointments for outpatient services because of factors such as fear of institutionalization or lack of transportation. 12. The home health nurse cares for an older adult patient who lives alone and takes several different prescribed medications for chronic health problems. Which intervention, if implemented by the nurse, would best encourage medication compliance? a)Use a marked pillbox to set up the patient’s medications. b)Discuss the option of moving to an assisted living facility. c)Remind the patient about the importance of taking medications. d)Visit the patient daily to administer the prescribed medications. ANS: A Because forgetting to take medications is a common cause of medication errors in older adults, the use of medication reminder devices is helpful when older adults have multiple medications to take. There is no indication that the patient needs to move to assisted living or that the patient does not understand the importance of medication compliance. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living or instrumental ADLs. 6A&E I Comprehensive Testbank13. The home health nurse visits an older patient with mild forgetfulness. Which new information is of most concern to the nurse? a)The patient tells the nurse that a close friend recently died. b)The patient has lost 10 lb (4.5 kg) during the past month. c)The patient is cared for by a daughter during the day and stays with a son at night. d)The patient’s son uses a marked pillbox to set up the patient’s medications weekly. ANS: B A 10-pound weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an 86-yr-old would have friends who have died. 14. Which statement, if made by an older adult patient, would be of most concern to the nurse? a. “I prefer to manage my life without much help from other people.” a)“I prefer to manage my life without much help from other people.” b)“I take three different medications for my heart and joint problems.” c)“I don’t go on daily walks anymore since I had pneumonia 3 months ago.” d)“I set up my medications in a marked pillbox so I don’t forget to take them.” ANS: C Inactivity and immobility lead rapidly to loss of function in older adults. The nurse should develop a plan to prevent further deconditioning and restore function for the patient. Self-management is appropriate for independently living older adults. On average, an older adult takes seven different medications so the use of three medications is not unusual for this patient. The use of memory devices to assist with safe medication administration is recommended for older adults. 15. The nurse assesses an older patient who takes diuretics and has a possible urinary tract infection (UTI). Which action should the nurse take first? a)Palpate over the suprapubic area. b)Inspect for abdominal distention. c)Question the patient about hematuria. d)Request the patient empty the bladder. ANS: D Before beginning the assessment of an older patient with a UTI and on diuretics, the nurse should have the patient empty the bladder because bladder fullness or discomfort will distract from the patient’s ability to provide accurate information. The patient may seem disoriented if distracted by pain or urgency. The physical assessment data are obtained after the patient is as comfortable as possible. 7A&E I Comprehensive Testbank16. Which patient is most likely to need long-term nursing care management? a)72-yr-old who had a hip replacement after a fall at home b)64-yr-old who developed sepsis after a ruptured peptic ulcer c)76-yr-old who had a cholecystectomy and bile duct drainage d)63-yr-old with bilateral knee osteoarthritis who weighs 350 lb (159 kg) ANS: D Osteoarthritis and obesity are chronic problems that will require planning for long-term interventions such as physical therapy and nutrition counseling. The other patients have acute problems that are not likely to require long-term management. 17. An older adult being admitted is assessed at high risk for falls. Which action should the nurse take first? a)Use a bed alarm system on the patient’s bed. b)Administer the prescribed PRN sedative medication. c)Ask the health care provider to order a vest restraint. d)Place the patient in a “geri-chair” near the nurse’s station. ANS: A The use of the least restrictive restraint alternative is required. Physical or chemical restraints may be necessary, but the nurse’s first action should be an alternative such as a bed alarm. 18. An older adult patient presents with a broken arm and visible scattered bruises healing at different stages. Which action should the nurse take first? a)Notify an elder protective services agency about possible abuse. b)Make a referral for a home assessment visit by the home health nurse. c)Have the family member stay in the waiting area while the patient is assessed. d)Ask the patient how the injury occurred and observe the family member’s reaction. ANS: C The initial action should be assessment and interviewing of the patient. The patient should be interviewed alone because the patient will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the patient should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document data before notifying the elder protective services agency. 19. The family of an older patient with chronic health problems and increasing weakness is considering placement in a long-term care (LTC) facility. Which action by the nurse will be most helpful in assisting the patient to make this transition? a)Have the family select a LTC facility that is relatively new. b)Ask the patient’s preference for the choice of a LTC facility. 8A&E I Comprehensive Testbankc)Explain the reasons for the need to live in LTC to the patient. d)Request that the patient be placed in a private room at the facility. ANS: B The stress of relocation is likely to be less when the patient has input into the choice of the facility. The age of the long-term care facility does not indicate a better fit for the patient or better quality of care. Although some patients may prefer a private room, others may adjust better when given a well-suited roommate. The patient should understand the reasons for the move but will make the best adjustment when involved with the choice to move and the choice of the facility. 20. The nurse manages the care of older adults in an adult health day care center. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? TestBankWorld.org a)Obtain information about food and medication allergies from patients. b)Take blood pressures daily and document in individual patient records. c)Choose social activities based on the individual patient needs and desires. d)Teach family members how to cope with patients who are cognitively impaired. ANS: B Measurement and documentation of vital signs are included in UAP education and scope of practice. Obtaining patient health history, planning activities based on the patient assessment, and patient education are all actions that require critical thinking and will be done by the registered nurse. MULTIPLE RESPONSE 1. Which nursing actions will the nurse take to assess for possible malnutrition in an older adult patient (select all that apply)? a)Assess for depression. b)Review laboratory results. c)Determine food preferences. d)Inspect teeth and oral mucosa. e)Ask about transportation needs. ANS: A, B, D, E The laboratory results, especially albumin and cholesterol levels, may indicate chronic poor protein intake or high-fat or high-cholesterol intake. Transportation affects the patient’s ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition. 9A&E I Comprehensive TestbankChapter 09: Cultural Awareness Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is working at a health fair screening people for liver cancer. Which population group should the nurse monitor most closely for liver cancer? ANS: B While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian population, they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic African-Americans. 2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? ANS: B Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans’ health overall has improved during the past few decades, the health of members of marginalized groups has actually declined. 3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? ANS: A While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. 4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence? a.Hispanicb.Asian Americansc.Non-Hispanic Caucasiansd.Non-Hispanic African-Americans a.There is a decreased frequency of morbidity.b.There is an increased incidence of disease.c.There is an increased level of health.d.There is a decreased mortality rate. a.Accessibility of health care servicesb.Outcomes of health conditionsc.Prevalence of complicationsd.Incidence of diseases a.Communicates effectively in a multicultural contextb.Functions effectively in a multicultural contextc.Visits a foreign countryd.Speaks a different language 10A&E I Comprehensive TestbankANS: B Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence. 5. The nurse learns about cultural issues involved in the patient’s health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? ANS: D The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person’s life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups). 6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? ANS: A Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding organizational forces are not the first steps. 7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication. Which area will the nurse assess for the “H”? ANS: B The “H” in ETHNIC stands for healers: Has the patient sought advice from alternative health practitioners? While health, history, and homeland are important, they are not components of “H.” 8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which action should the nurse take? a.Marginalized groupsb.Health care disparityc.Transcultural nursingd.Culturally congruent care a.Assessing own biases and attitudeb.Learning about the world view of othersc.Understanding organizational forcesd.Developing cultural skills a.Healthb.Healersc.Historyd.Homeland a.Use long sentences when talking.b.Look at the patient when talking. 11A&E I Comprehensive TestbankANS: B Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by using short sentences, but do not break your sentences. Observe the patient’s nonverbal and verbal behaviors. 9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients? ANS: A Although cultural competence and patient-centered care both aim to improve health care quality, their focus is slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care, rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims to elevate quality for all patients. 10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the nurse indicates successful implementation of this technique? ANS: C The Teach-Back technique asks open-ended questions, like what will you tell your spouse about changing the dressing, to verify a patient’s understanding. When using the Teach-Back technique do not ask a patient, “Do you understand?” or “Do you have any questions?” Does this make sense and do you think you can do this at home are closed-ended questions. Would you tell me if you don’t understand something so we can go over it is not verifying a patient’s understanding about the teaching. 11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures? ANS: B To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for about 30% of core measures. 12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use? c.Use breaks in sentences when talking.d.Look at only nonverbal behaviors when talking. a.Provides care to transgender patientsb.Provides care to restore relationshipsc.Provides care to patients that is individualizedd.Provides care to surgical patients a.Asks, “Does this make sense?”b.Asks, “Do you think you can do this at home?”c.Asks, “What will you tell your spouse about changing the dressing?”d.Asks, “Would you tell me if you don’t understand something so we can go over it?” a.Caucasiansb.Poor peoplec.Alaska Nativesd.American Indians a.Use partnered rather than married. 12A&E I Comprehensive TestbankANS: A Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice impacted by many factors. For example, provide options such as “partnered” under relationship status. For parents, use parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or significant other), listening and reflecting patient’s choice. Remember that some LGBT patients are also legally married. 13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse monitor mostclosely? ANS: A Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts, and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical attention. Caucasian youth, Asian Americans, and African-Americans are not as likely to attempt suicide resulting in medical attention. 14. A nurse is assessing a patient’s ethnohistory. Which question should the nurse ask? ANS: B An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home? 15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? ANS: B About 9 out of 10 people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients with high-school and college education are not identified in the vulnerable populations. b.Use mother rather than father.c.Use parents rather than guardian.d.Use wife/husband rather than significant other. a.Young bisexualsb.Young caucasiansc.Asian Americansd.African-Americans a.What language do you speak at home?b.How different is your life here from back home?c.Which caregivers do you seek when you are sick?d.How different is what we do from what your family does when you are sick? a.A patient 35 years oldb.A patient 68 years oldc.A patient with a college degreed.A patient with a high-school diploma 13A&E I Comprehensive Testbank16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using? ANS: D Organizations can implement equity-focused quality improvement by recognizing disparities and committing to reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is important, the focus is on the patients. Organizations should start by implementing a change on a small scale (pilot testing), learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act). 17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? ANS: A The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person’s life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients’ cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. 18. A nurse is assessing the patient’s meaning of illness. Which area of focus by the nurse is priority? ANS: A To provide culturally congruent care, you need to understand the difference between disease and illness. Illness is the way that individuals and families react to disease, whereas disease is a malfunctioning of biological or psychological processes. The way a patient interacts to family/social interactions is communication processes and family dynamics. MULTIPLE RESPONSE 1. A nurse is using Campinha-Bacote’s model of cultural competency. Which areas will the nurse focus on to become competent? (Select all that apply.) a.Document staff satisfaction.b.Focus on the family.c.Implement change on a grand scale.d.Reduce disparities. a.Provides care that fits the patient’s valued life patterns and set of meaningsb.Provides care that is based on meanings generated by predetermined criteriac.Provides care that makes the nurse the leader in determining what is neededd.Provides care that is the same as the values of the professional health care system a.On the way a patient reacts to diseaseb.On the malfunctioning of biological processesc.On the malfunctioning of psychological processesd.On the way a patient reacts to family/social interactions a.Cultural skillsb.Cultural desirec.Cultural transitiond.Cultural knowledge 14A&E I Comprehensive TestbankANS: A, B, D, E Campinha-Bacote’s model of cultural competency has five interrelated components: cultural awareness; cultural knowledge; cultural skills; cultural encounters; and cultural desire. Cultural transition is not a component of this model. 2. A nurse is using the RESPECT mnemonic to establish rapport, the “R” in RESPECT. Which actions should the nurse take? (Select all that apply.) ANS: A, C The “R” in RESPECT stands for rapport and includes the following behaviors: connect on a social level; seek the patient’s point of view; and consciously attempt to suspend judgment. The “S” stands for support and includes the behavior of helping the patient overcome barriers. The “P” stands for partnership and includes the following behaviors: be flexible with regard to issues of control and stress that you will be working together to address medical problems. The “C” stands for cultural competence and includes the behavior of knowing your limitations in addressing medical issues across cultures. 3. A nurse is using the explanatory model to determine the etiology of an illness. Which questions should the nurse ask? (Select all that apply.) ANS: B, C, E The questions for etiology include “What do you call your problem?” and “What name does it have?” Recommended treatment is asked by the question “How should your sickness be treated?” Pathophysiology is asked by the question “How does this illness work inside your body?” The course of illness is asked by the question “What do you fear most about your sickness?” MATCHING A nurse is using Campinha-Bacote’ s model of cultural competency to improve cultural care. Which actions describe the components the nurse is using? e.Cultural encounters a.Connect on a social level.b.Help the patient overcome barriers.c.Consciously attempt to suspend judgment.d.Stress that they will be working together to address problems.e.Know limitations in addressing medical issues across cultures. a.How should your sickness be treated?b.What do you call your problem?c.How does this illness work inside your body?d.What do you fear most about your sickness?e.What name does it have? a.In-depth self-examination of one’s own backgroundb.Ability to assess factors that influence treatment and carec.Sufficient comparative understanding of diverse groupsd.Motivation and commitment to continue learning about culturese.Cross-cultural interaction that develops communication skills 15