Bridge to Nclex Examination Assignment
The number of the question corresponds to the same-numbered outcome at the beginning of the chapter.
What are the leading determinants of a patient’s health (select all that apply)?
Family history of disease
Social and physical environment
Type and quality of medical care received
In identifying patients at the greatest risk for health disparities, the nurse would note that
patients who live in urban areas have readily available access to health care services.
cultural differences exist in patients’ ability to communicate with their health care provider.
a patient receiving care from a health care provider of a different culture will have decreased quality of care.
men are more likely than women to have their cardiovascular disease symptoms ignored by a health care provider.
Forcing one’s own cultural beliefs and practices on another person is an example of
Which statement most accurately describes cultural factors that may affect health?
Diabetes and cancer rates differ by cultural/ethnic groups.
There are limited ethnic variations in physiologic responses to drugs.
Most patients find that religious rituals help them during times of illness.
Silence during a nurse-patient interaction means the patient understands the instructions.
As part of the nursing process, cultural assessment is best accomplished by
judging the patient’s cultural values based on observations.
using a cultural assessment guide as part of the nursing process.
seeking guidance from a nurse from the patient’s cultural background.
relying on the nurse’s previous experience with patients from that cultural group.
Nurses play a key role in promoting health equity. An important mechanism to do this is to
discourage use of evidence-based practice guidelines.
insist that patients adhere to established clinical guidelines.
teach patients to use the Internet to find resources related to their health.
engage in active listening and establish relationships with patients and families.
What is the first step in developing cultural competence?
Create opportunities to interact with a variety of cultural groups.
Examine the nurse’s own cultural background, values, and beliefs about health and health care.
Learn about a multitude of folk medicines and herbal substances that different cultures use for self-care.
Learn assessment skills for different cultural groups, including cultural beliefs and practices and physical assessments.
When communicating with a patient who speaks a language that the nurse does not understand, it is important to first attempt to
have a family member interpret.
use a trained medical interpreter.
use specific medical terminology so there will be no mistakes.
focus on the translation rather than nonverbal communication.
M.S. is an 81-yr-old woman who came to the United States from India 4 years ago with her son and daughter-in-law and their 4 children. She has several health problems, including coronary artery disease, hypertension, osteoarthritis in her right hip, and diabetes.
Her daughter-in-law is the primary caregiver and often brings her to the urban community health clinic for a variety of health-related problems. Recently, M.S. has been having memory problems.
The entire family comes to the health clinic with M.S. Because English is a second language (Hindustani is their first language) for all the adult family members, the staff relies on the oldest granddaughter to interpret.
At this clinic visit, M.S. is presenting with shortness of breath. Through her granddaughter’s interpretation, she tells the nurse that she is having trouble walking up the stairs in the apartment building. The nurse does the history and assessment, checks her blood glucose (which is within normal limits), and tells her that she should get more exercise.
Given M.S.’s memory problems and limited English, the nurse does not complete a 24-hour dietary recall or teach her or the family about diabetes management. M.S. is scheduled for an appointment with the cardiologist for an evaluation of her hypertension and heart disease. Two weeks later, when she sees the cardiologist, her shortness of breath is much worse, and she is having chest pain. She is hospitalized immediately.
Meanwhile, the clinic supervisor is completing a chart audit for the clinic’s quality review program. She is reviewing M.S.’s chart and notices that, although she has been a patient in the clinic for 3 years, she has never received instructions on blood glucose monitoring or general diabetes management.
The clinic has a nurse diabetes educator who teaches individual patients and groups of patients with diabetes. The clinic manager reviews these findings with the nurse and asks why she has not recommended that M.S. see the diabetes educator. The nurse states that with M.S.’s memory problems and the language barrier, she assumed that M.S. and her family would not benefit from the consultation.
What type of health disparity has M.S. experienced?
What factors led to her not receiving the standard of care?
What other assessment should have been done at the initial visit?
Patient-Centered Care: What strategies may have worked to enhance patient education?
Patient-Centered Care: How would you assess M.S.’s religious and spiritual needs?
Quality Improvement: If you were the clinic manager, how would you recommend that the nurse improve her practice?