Practice for Exam 3 Multiple Choice Identify the choice that best completes the statement or answers the

question. 1. What should a nurse caring for clients of another culture be sure to do? a Alter personal nonverbal behaviors to reflect the cultural norms of the client. . b Keep all behaviors culturally neutral to avoid misinterpretation. . c Rely on friendly gestures to communicate caring for the client. . d Avoid any pretense of prejudice by treating the client in the same way as any other client. . 2. A nurse says, Im not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best. What is such a belief called? a Ethnocentrism . b Prejudice . c Racism . d Stereotyping . 3. A health care worker tells a nurse, It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them. What is such a global statement called? a Cultural imposition . b Ethnocentrism . c Racism . d Stereotyping . 4. At a local hospital, postpartum care policy requires that nurses observe the mother during infant care to assess the mothers ability to care for the new baby and to promote bonding. A new immigrant mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Otherwise, it is believed that the mother will be unable to care for the child because she will not have healed sufficiently. What will the culturally competent nurse do? a Allow family members to provide the babys care and assess the mothers knowledge of . child care through discussion. b Explain the importance of bonding and that all good mothers gladly assume these . responsibilities. c Explain that the process of postpartum recovery does not require this much rest and . require that she provide infant care. d Explain that she must abide by hospital policy because documentation of the mothers . ability to give the infant care is required for discharge. 5. When teaching a nutrition class to a student group with a large Hispanic population, the student health nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. What type of action does the nurses approach represent? a Primary prevention .

b Secondary prevention . c Tertiary prevention . d Both primary and secondary prevention . 6. A patient known to be Buddhist enters the hospital for some diagnostic tests just before lunch time. The nurse tells the aide passing out lunch trays to give a meal tray to the new patient, since no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. What did the nurse forget? a A physicians prescription is necessary before any food can be served. . b The patients Buddhist faith probably requires a vegetarian diet. . c The patient may be too frightened about the tests to want to eat very much. . d The patient may have diabetes or be allergic to some foods. .

7. A clinic nurse gives detailed information on how to apply for SCHIP to a new mother who moved to the Unites States from Russia about 10 years ago. The nurses next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible for COBRA (insurance available after employment is lost) and therefore does not discuss insurance at all. What error is the nurse making? a Covert intentional prejudice . b Covert unintentional prejudice . c Overt intentional prejudice . d Overt unintentional prejudice . 8. A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose, although the patient denies taking more than the label indicated. What is the most likely explanation? a The patient was taking more mediation in the hope of getting well faster. . b The patient was also taking folk medicines that had many of the same effects and perhaps . some of the same ingredients as the prescribed medication. c The patient truly did not understand and thought the dose being taken was correct. . d The patient had an idiosyncratic (unique) response to the medication and should have a . smaller dose ordered. 9. What will the nurse who wishes to assess the status of a communitys health examine? a Community awareness . b Health facilities . c Health care manpower .

d Vital statistics . 10. A nurse is working toward an objective to Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care. During which phase of the nursing process would determination of the objective occur? a Assessment phase . b Planning phase . c Implementation phase . d Evaluation phase . 11. A nurse is checking health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which step of the evaluation process is the nurses action? a Determining outcome goal measurement . b Goal setting . c Measuring the goal effect . d Evaluating the program . 12. What is the most important question to be considered for summative evaluation of a program designed to decrease obesity in school-age children? a Are school-age children satisfied with the program? . b Can parents and guardians support the program requirements? . c Has obesity in school-age children decreased? . d What is the program cost compared with the program benefit? .

13. A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which person might be most helpful as a key informant? a Hospital administrator . b Hispanic community leader . c National expert on cultural competency . d Politician or county official . 14. What would be the most interactive approach to assessing a communitys need? a Define needs based on the current health status of the community . b Examine past needs as identified by the agency as well as the community

. c Project future needs based on current trends . d Use past and current data to project future needs . 15. Which program exemplifies an emphasis on tertiary prevention? a Developing an in-school clinic that provides birth control counseling and contraception . b Providing a diabetes management program for persons with diabetes mellitus . c Providing cardiovascular fitness evaluations at annual health fairs . d Setting up free blood pressure screening at popular department stores and supermarkets . 16. After extensive assessment, a nurse is confident that he knows the highest-priority health care need for the community and begins planning an appropriate intervention. However, when the nurse presents the idea to a community forum, the attendees show essentially no interest in being involved. Knowing the importance of the health problem and the reason for the program, the nurse begins the implementation anyway. Based on these facts, what is the probable outcome of the intervention? a Community members will become increasingly positive about the new program. . b Others will recognize the importance of the program and become involved. . c The public health agency will both publicize and expand the program. . d The program will fail because of the communitys lack of interest. . 17. Besides the obvious ethical and moral factor, what is creating such a push for both public and private home health care agencies to adopt quality improvement programs? a Communities are increasingly demanding such programs. . b Nurses are encouraging other professionals to join in such efforts. . c The motivation for quality improvement is the ongoing competition between agencies. . d Reimbursement under government programs requires such programs. . 18. The nurse admits uncertainty over how to address the needs of a group of clients. The long-term nurse in the area suggests that the nurse review published evidence-based clinical guidelines. How can the nurse know these guidelines are reliable? a Because the agency supports their use . b Because the guidelines have been published . c Because the long-term nurse trusts them . d Because they are based on research and expert opinion . 19. What makes evaluation of client outcomes due to nursing intervention so difficult? a Client records may not include appropriate data.

. b Few tools exist to measure client outcomes. . c Many other factors can also affect client outcomes. . d Measuring client outcomes is extremely time consuming. .

20.The management team of the Central County Community Health Agency wants to analyze the cost of homebound client services. Which records are most likely to provide useful data? a Clinical records . b Financial records . c Morbidity and mortality records . d Provider service records . 21. Which quality management recommendation or process exemplifies tertiary prevention? a All new employees complete a program on fire safety that details what to do in the event . of a fire. b At the yearly employee picnic, teams compete in putting out trash can fires and in racing . while carrying mock victims, using safe evacuation techniques. c After evaluation of response to an actual fire, new procedures implemented in the fire . response protocol are distributed to employees. d Mock fire drills are carried out twice a year to assess response and readiness in the event . of a real fire. Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore a cultural assessment should be attempted. What specific questions should the nurse ask? Select all that apply. a Can you tell me where your family is from? . b Do you practice a particular religious faith? . c Have you ever been in an American hospital before? . d Is there anything special we need to know about your food preferences? . e What do you think helps you stay healthy? . f What did the physician tell you is wrong with you? . 23. Why do community health nurses try so hard to encourage members of the community to be partners in health programs? Select all reasons that apply. a Such partners will encourage their neighbors and friends to attend. . b Doing so is a moral obligation for community health nurses. . c Having many partners helps publicize the programs in the involved neighborhoods. . d Participation in planning results in having a vested interest in the outcome. . e Partners may contribute money, time, and effort to the planning of programs. . f Such partnerships result in increased effectiveness. .

24. What factors must be considered by the nurse when deciding which alternative interventions to implement? Select all that apply. a The expected effect or outcome of each possible intervention . b How interested others are in helping in any particular intervention . c The nurses own interest in implementing each intervention . d The likelihood that the intervention will resolve the problem . e Whether policies support such an intervention . f What the literature reveals about similar interventions by others . 25. What variables may suggest to the nurse that the community is open to change? Select all that apply. a Commitment to current processes and policies . b High social-economic status in the community as a whole . c Long history of dependence on the community health agency and its staff . d Minimal level of social participation by community members . e Presence of liberal, scientific, and democratic values . f Strong traditional beliefs and values .

Practice for Exam 3: Answer Section MULTIPLE CHOICE 1. ANS: A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care. DIF: Cognitive Level: Knowledge 2. ANS: A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that ones own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, The way we do it is the only right way to provide this care. DIF: Cognitive Level: Application 3. ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food. DIF: Cognitive Level: Application 4. ANS: A Culturally competent nursing care focuses on the specific patient, reflects the patients individual beliefs and values, and is provided with sensitivity. DIF: Cognitive Level: Analysis 5. ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring. DIF: Cognitive Level: Application 6. ANS: B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and dont eat meat. DIF: Cognitive Level: Application 7. ANS: C The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client. DIF: Cognitive Level: Application 8. ANS: B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients. DIF: Cognitive Level: Synthesis 9. ANS: D The status of community health involving physical indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g.,

hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process. DIF: Cognitive Level: Knowledge 10. ANS: BEvaluation begins in the planning phase, when goals and measurable objectives are established and goalattaining activities are identified. DIF: Cognitive Level: Application 11. ANS: C Measuring the goal effect is accomplished by reviewing the records and summarizing the incidence of a condition before and after the program. DIF: Cognitive Level: Application 12. ANS: C Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: Are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. DIF: Cognitive Level: Application 13. ANS: B Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. DIF: Cognitive Level: Application 14. ANS: D Stages used in assessing client need include the following: preactiveprojecting a future need; reactivedefining the problem based on past needs identified by the client or the agency; inactivedefining the problem based on the existing health status of the population to be served; and interactivedescribing the problem using past and present data to project future population needs. DIF: Cognitive Level: Knowledge 15. ANS: B The aim of tertiary prevention programs is to reduce complications from disease. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence). DIF: Cognitive Level: Application 16. ANS: D The needs to be met for the client population must be identified by both the client and the health provider. If the client population does not recognize the need, the program will usually fail. DIF: Cognitive Level: Knowledge 17. ANS: C Home health care agencies have increasingly adopted quality improvement programs because of the competition that exists. DIF: Cognitive Level: Knowledge 18. ANS: D Evidence-based practice guidelines are protocols or statements of recommended practice developed by professional organizations and based on scientific clinical data and research as well as expert opinion from extensive clinical experience. Such guidelines help a clinician in decision making. DIF: Cognitive Level: Application 19. ANS: C The major problem with outcome evaluation is determining which nursing care activities are

primarily responsible for causing changes in client status. In nursing, many uncontrolled factors in the field, such as environment and family relationships, have an effect on client status. DIF: Cognitive Level: Knowledge 20. ANS: D The provider service records include information about the numbers of clinic clients seen daily, home visits made daily, transportation and mileage, the providers time spent with the client, and the amount and kinds of supplies used. The provider service record is completed on a daily basis by each provider and is summarized monthly and annually to indicate trends in health care activities and costs relative to personnel time, transportation, maintenance, and supplies. A clinical record is the client health record. This would contain health information for a single client, would not generally include clinic costs, and would be an inefficient source because it identifies service to only one individual. Financial records include extraneous items for the clinic as a whole. Extracting specific data will not be as easy, because they will be from the provider service record. Morbidity and mortality records would not be suitable in this instance. DIF: Cognitive Level: Application 21. ANS: C Tertiary prevention involves activities that are carried out when evaluation indicates needed improvement. A program on fire safety is an example of primary prevention. The employee picnic activity and mock fire drills provide for evaluation of competency (screening) and are thus secondary prevention. DIF: Cognitive Level: Synthesis MULTIPLE RESPONSE 22. ANS: A, B, D, E Cultural assessment requires knowledge about the clients ethnic background, religious preference, food patterns, and health practices. Questions should be chosen to obtain such information in as courteous a way as possible. DIF: Cognitive Level: Application 23. ANS: D, F Although partners do indeed contribute time and effort in participation, the primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature. DIF: Cognitive Level: Application 24. ANS: A, B, D, E The nurse can list each possible intervention and then consider the resources or barriers to that particular intervention, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective. DIF: Cognitive Level: Application 25. ANS: B, E Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents. DIF: Cognitive Level: Application