Chapter 11: Assessing Culture
A nurse is conducting a cultural assessment. Which of the following should the nurse include in the assessment? Select all that apply. A. values B. communication C. physical health D. history of mental illness E. affiliations
A. values B. communication E. affiliations Explanation: A cultural assessment should include the client's values, affiliations (what culture the client self-identifies with, religion), cultural sanctions or restrictions, communication, health-related beliefs and practices, education background, nutrition, and socioeconomic considerations, among other factors. History of mental illness is not generally included in a cultural assessment. A physical assessment assesses physical health; however, a cultural assessment can take place during a physical exam and health history. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, CULTURAL ASSESSMENT, pp. 191-192.
The nurse is assessing a client in the emergency department who appears to be confused and unable to follow commands. When obtaining the client's social history, which of the following questions should the nurse ask first? A. "Have you consumed any alcohol today?" B. "Are you able to afford your medications?" C. "Are you married?" D. "Do you live in low-income housing?"
Correct response: "Have you consumed any alcohol today?" Explanation: Nurses should use their judgement regarding the appropriate timing of a social assessment considering the health encounter, and only ask the questions that are essential. Asking about drug and alcohol use is a priority as the client is confused and unable to follow commands. Determining housing status, ability to purchase medications, and marital status are not immediately essential questions to ask. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture.
Which statement by the nurse demonstrates a cultural bias? A. "The client is old and wouldn't be able to understand the discharge instructions." B. "I don't understand how a woman would be sexually interested in another woman." C. "The client is Muslim, so I'll need to arrange care around his need to pray five times a day." D. "American healthcare is really so much better than that provided by any other country."
Correct response: "American healthcare is really so much better than that provided by any other country." Explanation: A bias is based on the practice of applying one's own cultural beliefs and values when interpreting and judging the value of something. A prejudice is disapproving or negative attitude that is not rooted in fact or accurate information. Stereotyping involves a uniform image of one group that is believed by another group or a fixed, overgeneralized belief about a particular group. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Disease, Illness, Health State, p. 201.
A nursing instructor is teaching students about communication in different cultures. When discussing the meaning of hand gestures and body language in different cultures, the nurse realizes that further instruction is necessary when a student makes which statement? A. "I can make a circle with my thumb and forefinger and people of all cultures know it means OK." B. "A major hand gesture is one for indicating height." C. "If any hand gesture is used, always clarify if there seems to be a strange reaction on the other's part." D. "There are many different elements of body language and hand gestures."
Correct response: "I can make a circle with my thumb and forefinger and people of all cultures know it means OK." Explanation: There are many different elements of body language and hand gestures among different cultures. Using the hand to indicate height is a common gesture of Americans and Latins. Making a circle with the thumb and forefinger can mean OK for Americans but can be a definite and serious insult in many cultures. Therefore, if any hand gesture is used, the nurse should always clarify if there seems to be a strange or unexpected outcome on the other person's part. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, OBSERVATIONS TO BE MADE DURING THE CLIENT INTERVIEW AND PHYSICAL EXAMINATION, p. 197.
Which statement by the nurse demonstrates an understanding of the importance that a client's culture plays in the client's health and wellness? A. "I understand a client's culture if I am familiar with the client's ethnic values." B. "I need to understand the client's cultural background to best interpret the client's needs." C. "A disability is not a factor in determining a client's cultural needs." D. "A person's race is an effective characteristic of his or her cultural background."
Correct response: "I need to understand the client's cultural background to best interpret the client's needs." Explanation: Culture and ethnicity determines interpersonal communication style, as well as health beliefs, values, and practices. To accurately assess the health needs of clients, the nurse must assess clients within the context of their background. Race is not strongly associated with culture since it is a socially constructed concept. Ethnic values are only a part of what comprises a person's culture. A person's disability does place him or her into a unique culture that can present specific needs. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, CULTURAL COMPETENCE, pp. 185-186.
A nursing instructor is teaching nursing students about cultural competence. The instructor determines understanding when the students make which of the following statements? A. "The nurse must be aware of the client's beliefs and values to provide high-quality care." B. "Recognizing that a client is from a different culture is cultural competence." C. "Cultural competence is easy for all nurses to understand and achieve." D. "The nurse needs to assist clients with acculturation to Western beliefs and values."
Correct response: "The nurse must be aware of the client's beliefs and values to provide high-quality care." Explanation: To provide high-quality care, nurses must know how to assess what is normal or abnormal for all persons who seek care. This necessitates cultural competence. Assisting clients in changing their beliefs and values to Western values would be considered ethnocentric. Recognizing that someone is from a different culture is the first step in cultural competence, but would not indicate that someone has achieved full cultural competence. Cultural competence is not easy to all and may be difficult for some nurses to understand and achieve; even so, nurses and all health care providers must strive for cultural competence in order to provide the best care to clients. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, CULTURAL COMPETENCE, p. 186.
A family member of a dying client asks the nurse if they may perform certain rituals, such as praying and reading verses in the private hospital room. How should the nurse respond? A. Inform the family it would be too disruptive. B. Notify the nursing supervisor. C. Deny the request. D. Allow the request.
Correct response: Allow the request. Explanation: The nurse should respect cultural practices as long as they are not disruptive to other clients and do not pose a risk to the unit. The family's request can be carried out and should not cause disruption to other clients because the client has a private room; therefore, this request should be allowed. The nurse may notify the nursing supervisor, but this is not the best answer. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Approach to Providers, p. 195.
A nurse assesses a 4-year-old boy who experiences gas, a stomachache, and diarrhea after consuming lactose products. The nurse recognizes the data as what type of biological variation? A. Developmental B. Body surface C. Anatomic D. Biochemical
Correct response: Biochemical Explanation: This boy is demonstrating signs of lactose intolerance, which is an inability to digest lactose and is a type of biochemical variation among cultures. The number of lower-extremity venous valves varies between Caucasians and African Americans, a phenomenon that is an example of an anatomic variation. Developmental variation in childhood includes variation in motor development among different cultures. Surface variation comprises variations in secretions of sweat and earwax among cultures. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Disease, Illness, Health State, p. 203.
The client comes to the health care provider stating he has a sore throat and believes he needs an antibiotic. This is an example of what type of model for health? A. Alternative B. Spiritual C. Biomedical D. Complementary
Correct response: Biomedical Explanation: The biomedical model views health as the absence of disease and health is restored through prompt diagnosis and elimination of pathology. Alternative treatments are used in instead of conventional. Complementary treatments includes alternative an conventional treatments. Spiritual is based upon one's belief system. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, CULTURAL ASSESSMENT, p. 192.
Which of the following statements is true about biologic variation? A. Cultural practices produce biologic variation. B. Drug metabolism differences are not culture based. C. Both genetics and environment produce biologic variation. D. Race is based on physical variations.
Correct response: Both genetics and environment produce biologic variation. Explanation: Some aspects of biologic variation affect and are affected by cultural beliefs and behaviors. Genetics and environment, and their interaction, cause humans to vary biologically. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Disease, Illness, Health State, p. 203.
A client comes to the ED with lower abdominal pain. She is extremely emotional and moving wildly on the gurney. A nurse says to another nurse that the client is "way overdoing it." What action should the nurse take to best provide care for this client? A. Tell the physician the client is not hurting as much as she lets on B. Talk to the client's family to find out if this is the normal behavior for this client C. Move the client so she will not bother other clients in the department D. Conduct a cultural assessment to better understand the client's perception of pain and illness.
Correct response: Conduct a cultural assessment to better understand the client's perception of pain and illness. Explanation: Some cultures encourage sick clients to be pampered and express pain freely. Whatever the situation, nurses must display a nonjudgmental attitude, provide facts, and use a culturally specific approach when administering prescribed treatments. They must never interpret the client's inactivity and dependence as apathy, depression, or "being difficult" without first conducting a cultural assessment and gaining insight into the client's medical diagnosis and behavior. It is not appropriate for the nurse to tell the physician that the client is not in as much pain as she is letting on, to move the client away from other clients in the department, or to talk to the client's family to find out if this is the normal behavior for this client. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Concepts and Terms Related to Culture, p. 185.
The nurse is caring for a married female client who defers to her husband to answer all assessment questions. The nurse understands that it is common in some cultures for the male to hold a dominant role in the relationship. What stage of cultural awareness does the nurse display? A. Unconscious incompetence B. Unconscious competence C. Conscious incompetence D. Conscious competence
Correct response: Conscious competence Explanation: Conscious competence is consciously learning about the client's culture and providing culturally relevant interventions; aware of differences; able to have effective trans-cultural interactions. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Concepts and Terms Related to Culture, p. 185.
The nurse is caring for a client who is from another country, and states to the charge nurse, "I just don't know if the client really understands what I am saying, and I am not understanding the client either, even though he speaks English." What stage of cultural awareness is the nurse experiencing? A. Unconscious competence B. Unconscious incompetence C. Conscious competence D. Conscious incompetence
Correct response: Conscious incompetence Explanation: Conscious incompetence is the awareness that one lacks knowledge about another culture; aware that cultural differences exist but not knowing what they are or how to communicate effectively with clients from different cultures. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Concepts and Terms Related to Culture, p. 185.
A new graduate nurse from a small community college is going to work in an urban setting. She embraces the thought of working in a more diverse setting and wants to learn about different cultures. What behavior is this nurse exhibiting? A. Conscious incompetence B. Cultural skill C. Cultural knowledge D. Cultural desire
Correct response: Cultural desire Explanation: Cultural desire is the motivation to engage in intercultural encounters and acquire cultural competence. The starting point of cultural competence is cultural desire. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, CULTURAL COMPETENCE, p. 186.
A nurse is assessing a client from India who complains of panic, sexual dysfunction, fatigue, weakness, and loss of appetite. Which culture-bound syndrome should the nurse suspect in this client? A. Dhat B. Latah C. Koro D. Wind illness
Correct response: Dhat Explanation: Dhat is a culture-bound syndrome of India and includes symptoms of panic, sexual complaints, fatigue, weakness, loss of appetite, guilt, and sexual dysfunction with no physical findings. Latah is a culture-bound syndrome of Malaysia that occurs after a traumatic episode or surprise. Symptoms include an exaggerated startle response (usually in women), screaming, cursing, dancing, hysterical laughter, imitation of people, and hyper-suggestibility. Wind illness is a culture-bound syndrome of Asia that features symptoms including fear of wind or cold exposure causing a loss of yang energy. Koro is a culture-bound syndrome of Malaysia and Southeast Asia that features a fear that genitalia will retract into the body, possibly leading to death. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Disease, Illness, Health State, p. 201.
The nurse is assessing a client and notices that when being asked questions, the client does not make eye contact. The nurse should include what in the plan of care? A. Minimal eye contact due to culture B. Uncomfortable answering questions. C. History of abuse D. Fear of authority
Correct response: Minimal eye contact due to culture Explanation: Some cultures make minimal eye contact out of respect. There is no indication the client is fearful of authority, uncomfortable answering questions or has been abused. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, OBSERVATIONS TO BE MADE DURING THE CLIENT INTERVIEW AND PHYSICAL EXAMINATION, p. 197.
A nurse is performing a focused assessment on a newly admitted client. The client recently emigrated from Central America. The client is talking about the evil eye in a partial use of the dominant language. What is the best response of the nurse? A. Document abnormal findings for culture. B. Ask the family, "How long has this been going on?" C. Obtain a translator. D. Request a Catholic priest.
Correct response: Obtain a translator. Explanation: The priority for the nurse is to obtain a translator and ask the client how they usually seek advice or care when they are ill, so that the health care team can provide culturally competent care. The nurse should not assume that the client is Catholic, especially since the evil eye is not part of the Catholic religion. Asking the family "How long has this behavior been going on?" implies that it is abnormal, when in fact avoiding the evil eye is a traditional preventative measure in Central and South America, and therefore this can be considered a normal finding. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Approach to Providers, p. 194.
A client of Native American/First Nations (Navajo) heritage is admitted to the hospital with dizziness, hallucinations, and loss of consciousness. The client is now awake, alert, and oriented. The nurse interviews the client and the client states he has been preoccupied with the death of someone close to him. The client's father states this reaction is common in his culture. Which of the following culture-bound syndromes is this client experiencing? A. bad blood B. ghost sickness C. bulimia D. empacho
Correct response: ghost sickness Explanation: Ghost sickness is a culture-bound syndrome seen in Native American/First Nations (Navajo) societies. The client may have feelings of danger, confusion, futility, suffocation, bad dreams, fainting, dizziness, hallucinations, loss of consciousness, or preoccupation with death or someone who died. Empacho is a culture-bound syndrome seen in Latin (American or Mediterranean) societies. It is seen in children: soft foods are believed to adhere to the stomach wall causing gastrointestinal symptoms. Bulimia is a culture-bound syndrome seen in North America and Western Europe. It is a disordered approach to eating that originates from an intense fear of obesity. Bad blood is a culture-bound syndrome seen in African societies. It means blood is contaminated and the term often refers to sexually transmitted diseases. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, TABLE 11-2 Culture-Bound Syndromes, p. 200.
The nurse and a client are developing a transcultural nursing care plan related to hypertension. The nurse will include in the plan: A. referral to a cardiac specialist. B. nutritional information specifically for the client's culture. C. educational materials given to all clients with hypertension. D. contact number for the cardiac rehabilitation program at the medical center.
Correct response: nutritional information specifically for the client's culture. Explanation: Compare the nutrients of foods not usual in the United States with nutrition charts to understand how healthy a diet is, especially with regard to diseases such as hypertension. It is very difficult to get a client to change usual dietary habits drastically, even with knowledge of the interaction of diet and disease. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 11: Assessing Culture, Factors Affecting Disease, Illness, Health State, p. 201.
