NUR 155/156 • Units 9-12
UPGRADED CONDENSED EXAM GUIDE
Textbook Learning Outcomes + Professor PowerPoints
Ch. 21 Culture & Ethnicity • Ch. 35 Medication Administration • Ch. 36 Pain • Ch. 42 Death & Loss
HOW TO USE THIS Study the bold rule first. Then cover the bullets and teach the concept back. Finish by asking: What
can harm my patient? What must I assess first? What is the safest nursing action?
CHAPTER 21 • CULTURE & ETHNICITY
CORE DECISION PATH Do not assume → assess the individual → communicate appropriately → preserve safe cultural
practices → negotiate when possible → repattern only when a practice is harmful.
LO 21.1 • Culture vs. Ethnicity
Culture = learned, symbolic, shared, integrated beliefs/values/behaviors. Ethnicity = identification with a cultural,
racial, or national group.
EXAM LENS If an answer assigns a belief to a patient only because of group membership, it is probably stereotyping.
Assess the person.
Professor emphasis: culture is learned through enculturation; language is symbolic; gender roles may be shared; a change
in one cultural area can affect the whole.
Transcultural nursing goal: culturally congruent care.
LO 21.2 • Cultural Concepts
Know the vocabulary because these are easy application-question distractors.
Acculturation = exchange of cultural features after first-hand contact.
Assimilation = one group/individual blends into another group.
Diffusion = borrowing traits between cultures.
Ethnocentrism = viewing one's own culture as superior and judging others by one's own standards.
TEST TRICK Acculturation = exchange. Assimilation = blend/merge. Diffusion = borrow. Ethnocentrism = 'my way is
better.'
LO 21.3 • Acquisition of Cultural Identity
Cultural identity develops through socialization and institutions.
Family • community • school • spiritual/religious institutions • rituals
LO 21.4 • Transcultural Nursing
Madeleine Leininger = culturally congruent nursing care; Sunrise Model; Theory of Cultural Care Diversity and
Universality.
LEININGER CUE Question asks how the nurse can preserve, accommodate/negotiate, or repattern a cultural practice →
think LEININGER.
, LO 21.5 • Cultural Competence
Cultural competence requires openness and balancing the nurse's culture, the health-care system, and the client's
culture.
PATIENT SAFETY / NURSING JUDGMENT Respect does not mean automatically accepting an unsafe practice. Explore
meaning, identify risk, then collaborate on a safe culturally acceptable plan.
LO 21.6 • Culture + Nursing Process
Assessment comes before culturally appropriate intervention.
EXAM LENS Question asks what to assess about culture → think GIGER & DAVIDHIZAR / individualized cultural
assessment. Question asks how to adapt care → think LEININGER.
Assess: communication/language, skin color considerations, gender roles/identity, time orientation, body odor practices,
nutrition, spirituality/religion, health beliefs, socioeconomic level.
Care plan: cultural maintenance/preservation; accommodation/negotiation; repatterning/restructuring; language needs;
individualized care; community referrals.
Title VI professor point: federally funded programs cannot discriminate based on race, color, or national origin.
CHAPTER 35 • MEDICATION ADMINISTRATION
CORE DECISION PATH Order → verify patient/allergies → assess whether the drug is safe NOW → calculate/prepare → 3
checks + 6 rights → administer correctly → document → evaluate response.
LO 35.1 • Regulations
Medication production, distribution, prescribing, and administration are regulated by law.
FDA enforces medication legislation and safety testing.
DEA monitors controlled-substance compliance; controlled substances are scheduled.
Facility policy must follow federal/state/local regulations and may be more restrictive.
Nurse Practice Act defines nursing functions and responsibilities; a facility cannot expand the Act.
LO 35.2 • Drug Actions
Pharmacokinetics = what the body does to the drug: absorption → distribution → metabolism → excretion.
EXAM LENS Organ dysfunction, age, dose, route, and frequency can change medication response.
Therapeutic effect = desired response.
Pharmacodynamics = biochemical/physiologic response of the body.
Onset = time until response; peak = highest serum level; trough = lowest; half-life = time for concentration to fall by half.
Differentiate side effect, adverse effect, toxic effect, allergic/anaphylactic reaction, idiosyncratic reaction.
Interactions: synergism increases combined effect; antagonism reduces/opposes effect; verify compatibility before mixing
medications.
LO 35.3 • Prescription vs. Nonprescription
Medication history must include prescriptions, OTC drugs, vitamins, herbs, and alternative therapies.
PATIENT SAFETY / NURSING JUDGMENT Herbal/OTC does NOT mean harmless. Assess for interactions, allergies,
UPGRADED CONDENSED EXAM GUIDE
Textbook Learning Outcomes + Professor PowerPoints
Ch. 21 Culture & Ethnicity • Ch. 35 Medication Administration • Ch. 36 Pain • Ch. 42 Death & Loss
HOW TO USE THIS Study the bold rule first. Then cover the bullets and teach the concept back. Finish by asking: What
can harm my patient? What must I assess first? What is the safest nursing action?
CHAPTER 21 • CULTURE & ETHNICITY
CORE DECISION PATH Do not assume → assess the individual → communicate appropriately → preserve safe cultural
practices → negotiate when possible → repattern only when a practice is harmful.
LO 21.1 • Culture vs. Ethnicity
Culture = learned, symbolic, shared, integrated beliefs/values/behaviors. Ethnicity = identification with a cultural,
racial, or national group.
EXAM LENS If an answer assigns a belief to a patient only because of group membership, it is probably stereotyping.
Assess the person.
Professor emphasis: culture is learned through enculturation; language is symbolic; gender roles may be shared; a change
in one cultural area can affect the whole.
Transcultural nursing goal: culturally congruent care.
LO 21.2 • Cultural Concepts
Know the vocabulary because these are easy application-question distractors.
Acculturation = exchange of cultural features after first-hand contact.
Assimilation = one group/individual blends into another group.
Diffusion = borrowing traits between cultures.
Ethnocentrism = viewing one's own culture as superior and judging others by one's own standards.
TEST TRICK Acculturation = exchange. Assimilation = blend/merge. Diffusion = borrow. Ethnocentrism = 'my way is
better.'
LO 21.3 • Acquisition of Cultural Identity
Cultural identity develops through socialization and institutions.
Family • community • school • spiritual/religious institutions • rituals
LO 21.4 • Transcultural Nursing
Madeleine Leininger = culturally congruent nursing care; Sunrise Model; Theory of Cultural Care Diversity and
Universality.
LEININGER CUE Question asks how the nurse can preserve, accommodate/negotiate, or repattern a cultural practice →
think LEININGER.
, LO 21.5 • Cultural Competence
Cultural competence requires openness and balancing the nurse's culture, the health-care system, and the client's
culture.
PATIENT SAFETY / NURSING JUDGMENT Respect does not mean automatically accepting an unsafe practice. Explore
meaning, identify risk, then collaborate on a safe culturally acceptable plan.
LO 21.6 • Culture + Nursing Process
Assessment comes before culturally appropriate intervention.
EXAM LENS Question asks what to assess about culture → think GIGER & DAVIDHIZAR / individualized cultural
assessment. Question asks how to adapt care → think LEININGER.
Assess: communication/language, skin color considerations, gender roles/identity, time orientation, body odor practices,
nutrition, spirituality/religion, health beliefs, socioeconomic level.
Care plan: cultural maintenance/preservation; accommodation/negotiation; repatterning/restructuring; language needs;
individualized care; community referrals.
Title VI professor point: federally funded programs cannot discriminate based on race, color, or national origin.
CHAPTER 35 • MEDICATION ADMINISTRATION
CORE DECISION PATH Order → verify patient/allergies → assess whether the drug is safe NOW → calculate/prepare → 3
checks + 6 rights → administer correctly → document → evaluate response.
LO 35.1 • Regulations
Medication production, distribution, prescribing, and administration are regulated by law.
FDA enforces medication legislation and safety testing.
DEA monitors controlled-substance compliance; controlled substances are scheduled.
Facility policy must follow federal/state/local regulations and may be more restrictive.
Nurse Practice Act defines nursing functions and responsibilities; a facility cannot expand the Act.
LO 35.2 • Drug Actions
Pharmacokinetics = what the body does to the drug: absorption → distribution → metabolism → excretion.
EXAM LENS Organ dysfunction, age, dose, route, and frequency can change medication response.
Therapeutic effect = desired response.
Pharmacodynamics = biochemical/physiologic response of the body.
Onset = time until response; peak = highest serum level; trough = lowest; half-life = time for concentration to fall by half.
Differentiate side effect, adverse effect, toxic effect, allergic/anaphylactic reaction, idiosyncratic reaction.
Interactions: synergism increases combined effect; antagonism reduces/opposes effect; verify compatibility before mixing
medications.
LO 35.3 • Prescription vs. Nonprescription
Medication history must include prescriptions, OTC drugs, vitamins, herbs, and alternative therapies.
PATIENT SAFETY / NURSING JUDGMENT Herbal/OTC does NOT mean harmless. Assess for interactions, allergies,
