Exam #3: Cultural Diversity

*Question:*An African American patient complains of gas after eating a bedtime snack of cheese and crackers. This may be a symptom of which of the following conditions? 1) Lactose intolerance 2) Keloid formation 3) Thalassemia 4) G6PD deficiency

Correct answer: *1* p. 27. Various studies have shown that certain racial and ethnic groups are more prone to developing specific diseases and conditions. Common health problems among African Americans include hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids.

*Question:*In which of the following ethnic groups would folk-healing practices and home remedies be used by some families for particular illnesses? 1) African American 2) White middle class 3) Asian 4) Jewish descent

Correct answer: *1* p. 34, box 2-5. African Americans may still use various folk healing practices and home remedies for treating particular illnesses. This varies extensively and may include spiritualists, herb doctors, root doctors, conjurers, skilled elder family members, voodoo, and faith healing.

*Question:*The belief that one's own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others is best defined as: 1) Ethnicity 2) Ethnocentrism 3) Cultural blindness 4) Cultural assimilation

Correct answer: *2* p. 32. Ethnocentrism is describes as the belief that one's own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. When health professionals assume that they have the right to make choices and decisions for patients, of hen respond to such an attitude by the dominant culture.

*Question:*If a patient refuses to allow the nurse to draw blood for a test because he believes blood is the body's life forces and cannot be regenerated, it is likely that he belongs to which of the following ethnic groups? 1) Hispanic-Puerto Rican 2) Asian 3) Hispanic-Mexican 4) African American

Correct answer: *2* p. 34, box 2-5. Nursing considerations for a patient of Asian descent include: some members of the Asian cultures may be upset by the drawing of blood for lab tests. They consider blood to be the body's life force, and some do not believe that it can be regenerated.

*Question:*Which of the best describes the type of health promotion practiced by Hawaiians? 1) One should eat a diet balanced with yin and yang foods and maintain harmony with friends and family 2) Past illness is viewed as part of the whole and there is an emphasis on preventative medicine with treatment using medicinal plants and minerals 3) Proper diet, proper behavior, and exercise in fresh air are prescriptions for maintaining health 4) Illness is seen as preventable; nutrition is important, but not physical activity.

Correct answer: *2* p. 35. Hawaiian's view a patient's illness as part of the whole. Hispanics believe God gives health and allows illness for a reason. Treatments use more than 300 medicinal plants and minerals.

*Question:*Which of the following statements would best apply to Native American cultures? 1) The family is not expected to part of nursing care. 2) Direct eye contact is preferred when speaking to healthcare professionals 3) A low tone of voice is considered respectful 4) Careful notes are kept regarding home car and medications

Correct answer: *3* p. 35, box 2-5. Nursing considerations for Native American cultures include: indirect eye contact is acceptable and sometimes preferred, note taking is taboo, a low tone voice is often considered respectful, and a patient may expect the caregiver to deduce the problem through instinct and not through asking many questions and history taking.

*Question:*The use of eye contact varies from culture to culture. Which of the following assumptions may be accurate when eye contact is used as nonverbal communication by different cultural groups in the following situations? 1) A Native American stares at the floor while talking with the nurse. Assumption: He is embarrassed by the conversation. 2) A Hasidic Jewish man listens intently to a male physician, making direct eye contact with him, but refuses to make eye contact with a female nursing student. Assumption: Jewish men consider women inferior to men. 3) A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest. 4) An African American man rolls his eyes when asked how he copes with stress in the workplace. Assumption: He may feel he has already answered this question and has become impatient.

Correct answer: *3* p.29. One of the most culturally variable forms of nonverbal communication is eye contact. The American dominant culture emphasizes eye contact while speaking, but other cultures regard this behavior in different ways. Muslin-Arab women indicate modesty by avoiding eye contact with men. Hasidic Jewish men tend to avoid direct eye contact with women.

*Question:*A 79 year old Native American woman is placed in a nursing home by her son, who is no longer able to care for her. She appears disoriented and complains of the "bright lights and constant activity". Her feelings are likely to be a result of which of the following conditions. 1) Culture assimilation 2) Culture disorientation 3) Culture blindness 4) Culture shock

Correct answer: *4* p. 26. Culture shock is defined as feeling a person experiences when placed in a different culture perceived as strange. Culture shock may result in psychological discomfort or disturbances, as the patterns of behaviors a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new one. The person may feel foolish, fearful, incompetent, inadequate, or humiliated.

*Question:*Which of the following statements about food accurately reflects foods that are dibble for various cultural groups? 1) For some Asians, Hispanics, and Seventh-Day Adventists, religious beliefs prohibit the consumption of pork 2) Patients following a vegetarian diet generally eat chicken 3) Vietnamese patients will not eat beans 4) French patients consider corn to be animal feed

Correct answer: *4* p. 29, box 2-1. Dietary teaching must be individualized according to cultural values about the social significance and sharing of food. A culturally sensitive assessment of nutrition should be provided. In France, corn is considered an animal feed, whereas corn is a commonly eaten vegetable in the US.

*Question:*Nursing is a subculture of which of the following larger cultures in our society? 1) Healthcare providers 2) Organizations of nurses 3) Institutions 4) Healthcare systems

Correct answer: *4* p.31. The healthcare system is itself a culture with customs, rules, values, and a language of its own, with nursing as its largest subculture.

*Question:*A nurse is assigned the care of a client who speaks only French. The nurse does not know the language. What action is appropriate for the nurse in this case? A. Request of professional interpreter B. Ask another nurse to take care of the client C. Refuse to take care of the client D. Communicate with the client non-verbally

Correct answer: *A* In a situation in which the nurse is assigned care of the non-English speaking client, the nurse should request a professional interpreter. However, the nurse should not refuse to take charge of the client because the nurse cannot refuse his or her duty. Non-verbal communication with the client through gestures would not give complete information, and therefore it is not appropriate for this situation. The nurse may take help from another nurse who is appropriately bilingual.

*Question:*A Chinese client is admitted to the health care facility with blockage in the coronary arteries. The cardiologies advises the client to undergo angioplasty. The client refuses the procedure. Late the nurse discovers that the client believes in naturopathy and is taking herbal extracts to unclog his coronary arteries. Which of the following suggestions should the nurse give to the client? A. Ask the client to opt for herbal therapy and also undergo surgery B. Warn the client that the majority of the herbalists are all quacks C. Tell the client that herbal therapy has not proven to be effective D. Tell the client that herbal medicines could lead to other complications

Correct answer: *A* The nurse should suggest that the client try both the surgery ad well as the herbal medicine. Considering the individuality of health beliefs and the risk of not getting operated on a in a timely manner, the nurse should encourage the client to undergo the surgery and simultaneously continue his herbal extract treatment. In stating that herbs are not effective, the nurse does not respect the client's beliefs. Assuming that herbal medicines could lead to further complications is non-therapeutic because the nurse includes personal opinion in the discussion. The nurse should avoid showing disapproval of the client's choice of healing because this does not make for good communication.

*Question:*Health care facilities that sponsor health-promotion activities only in affluent areas are considered what? A. Culturally affluent B. Culturally blind C. Culturally sensitive D. Culturally different

Correct answer: *B* Another way of thinking about ethnocentrism is nursing is that it can reflect an individual's, a group's, or an agency's cultural blindness. It can also reflect a lack of capacity to reach out effectively to minorities or culturally stigmatized groups

*Question:*In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which of the following principles? A. The nurse should avoid performing health promotion education if this is not a priority in the client's culture B. The client may have a very different understanding of health promotion C. A culture's conceptualization of health promotion is a result of that culture's level of socioeconomic development

Correct answer: *B* As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the patient may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among priority in a client's culture, this does not necessarily mean that the nurse should not address issues related to health promotion is a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.

*Question:*A student nurse is preparing a presentation regarding different cultures. Which definition of culture is most accurate? A. Altruistic group B. Belief system that guides behavior C. Cluster of individuals D. Complete uniformity of memebers

Correct answer: *B* Culture is a belief system that the members of the culture hold, to varying degrees, consciously or unconsciously, as absolute truth. The belief system guides everyday and makes it routine.

*Question:*How is culture learned by each new generation? A. Ethnic heritage B. Formal and informal experiences C. Involvement in religious activities D. Belonging to a subculture

Correct answer: *B* Culture is a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned through formal and informal experiences within one's family and the cultural group to which one belongs.

*Question:*Which of the following areas are typically included in a cultural assessment? A. Employment status B. Food preferences C. Marital status D. Ethnics

Correct answer: *B* Dietary tolerance is associated with both cultural food preferences and biological variation

*Question:*When a home-bound client expresses her past-oriented ancestral heritage and family rituals, the nurse recognizes that the patient is expressing what? A. Assimilation B. Ethnic identity C. Subculture D. Race

Correct answer: *B* Ethnicity or ethnic identity refers to self conscious, past-oriented form of identity based on a notion of shared culture and perhaps ancestral heritage, and current position in larger society. Race is based on biologic characteristics; assimilation refers to new customs and attitudes that are acquired through contact and communication among persons of a particular culture; subculture refers to a group of people within a culture who have ideas and beliefs which are different from the rest of that society.

*Question:*A non English-speaking client has been admitted to the health care facility with complaints of chest pain. Since the assigned nurse does not know the client's language, what would be the most appropriate solution in this case? A. The nurse should get a language dictionary and translate B. The nurse should request the help of professional interpreter C. The nurse should communicate with the client non-verbally D. The nurse should ask the supervisor for a different assignment

Correct answer: *B* The nurse should request the help of a professional interpreter to communicate effectively with the non-English-speaking patient. Trying to use a language dictionary to help communicate may be troublesome and time-consuming. Answer C is inappropriate because the nurse cannot shun his or her responsibilities. Asking the patient to communicate non-verbally may lead to break in communication or misinterpretations.

*Question:*A nurse is caring for an Asian American client immediately postpartum. As the client seems exhausted after delivery, the nurse offers her warm milk to drink. The client refuses, saying that her cultural belief does not permit her to have any food before 24 hours have passes. What is the most appropriate response by the nurse? A. Put in an IV and start intravenous fluid to avoid dehydration B. Explain the importance of the mother's nutritional status for lactation C. Tell the client that her beliefs are wrong and she needs to have food D. Call the nurse supervisor and inform her about the client

Correct answer: *B* The nurse should respect the client's cultural beliefs and explain the importance of the nutritional status for the mother's, as well as the baby's, health. IV fluids are given only when the client cannot take food orally. Informing the nurse supervisor is inappropriate and irrelevant. Telling the client that her beliefs are wrong and she needs to have food devalues the client's beliefs.

*Question:*A parent informs the nurse that immunizations are against her cultural and religious beliefs and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be consistently ill and will not be allowed to start school unless immunized. The nurse also informs the parent that she had all of her children vaccinated. What is the nurse's behavior an example of? A. Cultural blindness B. Cultural imposition C. Cultural conflict D. Stereotyping

Correct answer: *B* The nurse's behavior is an example of cultural imposition, defined as the tendency to impose one's cultural beliefs, practices, and values on a person from a different culture.

*Question:*The children of an elderly male client who has suffered an ishemic stroke have informed the nurse that an herbalist will be coming to their father's bedside tomorrow to make recommendations for his care. Which of the following consideration should the nurse prioritize in light of the practitioner's planned visit? A. Identify whether the family would prefer to pursue alternative or conventional treatment for their father B. Ensure any complementary therapies are safe when combined with his prescribed treatments C. Ensure that the care team does not impose their beliefs on the family of the complementary practitioner D. Take measures to prevent cultural conflict when the practitioner comes to the hospital

Correct answer: *B* While it is important for the nurse and other members of the care team to ensure that stereotypes or cultural imposition do not exist, the priority in all aspects of care is patient safety. Consequently, potential interactions between the complementary therapies and conventional hospital treatments are a priority. The family should not be required to forego conventional treatment in order to pursue some aspects of culturally based, complementary care.

*Question:*In which of the following populations should the nurse carefully assess the client's use of over the counter medications? A. Asian B. Hispanic C. White middle class D. African American

Correct answer: *C* In the white middle class population, use of over the counter drugs (especially vitamins and analgesics) is common and should be assessed by the nurse.

*Question:*A client from Pakistan informs the nurse of his cultural dietary requests. The nurse responds to the special dietary need by stating, "You are now living in the United States, and you should try and start eating those foods common to an America diet." This inappropriate response in an example of what? A. Cultural diversity B. Cultural blindness C. Cultural imposition D. Cultural assimilation

Correct answer: *C* The nurse's response is an example of cultural imposition, which is defined as the belief that everyone should conform to the majority belief system. Cultural blindness is the result of ignoring differences and proceeding as though they do not exist. In this situation, the nurse did not ignore the request but inappropriately responded to it. Cultural diversity is defined as a diverse group in society, with varying racial classifications and national origins, religious affiliations, languages, physical sizes, genders, sexual orientations, ages, disabilities, socioeconomic statuses, occupational statuses, and geographic locations. Cultural assimilation occurs when members of a minority group live within a dominant group and lose the cultural characteristics that make them different.

*Question:*Which of the following statements best conveys the relationship between race and ethnicity? A. Race and ethnicity are both culturally determined concepts B. Race is based on an individual's cultural history and is independent of ethnicity C. Race denotes physical characteristics while ethnicity is rooted in a common heritage D. Race and ethnicity can be considered to be synonymous in the context of health care

Correct answer: *C* The term "race" is usually used in reference to particular physical characteristics, while ethnicity is an identification with a cultural group that is often based on a common heritage. Because it is rooted in objective physical traits, race is usually considered to be somewhat independence of culture.

*Question:*A Malaysian client is admitted to the health care facility with complaints of cramping in pain in the abdomen and loose stools. Where should the nurse be seated when interviewing the client? A. Behind the client B. Alongside the client C. At more than one arm's distance D. In one corner of the room

Correct answer: *C* While interviewing the Malaysian client, the nurse should sit at a distance of more than one arm's length from the client. The nurse should not sit alongside the client, as he may feel uncomfortable. If the nurse sits at the back of the client, the nurse may not observe the client's body language. If the nurse sits in a corner of the room, communication may not be effective.

*Question:*An elderly Cantonese-speaking client has been admitted to the emergency department after suffering a fall and suspected hip fracture in her home. Emergency medical services personnel have reported to the nurse that the client speaks no English. Who is the best person to perform translation services to the client? A. A Cantonese-speaking hospital employee B. A family member C. A trusted friend D. A hospital translator

Correct answer: *D* A qualified interpreter who is familiar with health care terminology is the best choice for providing translation for patients. Such a person is more likely to be objective and well versed in requisite vocabulary than a friend, family member, or hospital employee.

*Question:*An Asian American client is admitted to the health care facility hypoglycemia. After the client is stable, the nurse discovers that the client has not had his prescribed medicines. The client believes that eating saffron will keep his blood sugar under control. What is the most appropriate response by the nurse? A. "Yes, I agree that you should continue taking saffron for diabetes." B. "Let me inform the physician that you are not taking your medicines." C. "Saffron does not have any effect on blood sugar level." D. "Why don't you take the medicines, too, and benefit from both?"

Correct answer: *D* Although the nurse may disagree with the client's beliefs concerning the cause of health or illness, respect for these beliefs helps the client to achieve health care goals. Asking the client to consider the benefits of medicine is appropriate because the nurse, without disrespecting the client's beliefs, persuades him to have medicine also. Stating that saffron does not have any affect on blood sugar is inappropriate, as it disregards the client's belief. Agreeing with the client may encourage him and indicative low faith in the present treatment. It is inappropriate to call the doctor and complain about the client.

*Question:*Which of the following is the tendency to impose once's cultural beliefs, values, and patterns of behavior on a person or people from a different culture? A. Cultural blindness B. Acculturation C. Cultural taboos D. Cultural imposition

Correct answer: *D* Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Acculturation in the process by which members of a cultural group adapt to, or learn how to, take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.

*Question:*The nurse is caring for a terminally ill patient whose family has requested to hold a spiritual ceremony, during which they will be using incense. What would be the best intervention you could make on behalf of this patient? A. Discourage the use of incense in the hospital B. Discourage the family from performing the ceremony C. Refuse the ceremony because it may affect other patients in the unit D. Arrange for the ceremony to occur after obtaining permission from administration

Correct answer: *D* Culturally competent polices seek to plan and implement care in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society. Thus, the nurse should make, or help to make, the arrangements for the ceremony.

*Question:*The nurse is caring for a client who speaks a language other than English and is using an interpreter to communicate. What would be the best way to choose an interpreter for this client? A. Interpreter should conduct the conversation quickly to avoid misinterpretation B. Interpreter should always make direct eye contact C. Interpreter should speak in a loud voice D. Interpreter should understand the health care system

Correct answer: *D* Obviously, nurses cannot become fluent in all languages, but certain strategies for fostering effect cross-cultural communication are necessary when providing care for clients who are not fluent in English. Culture needs should be considered when choosing an interpreter; however it is also important to use an interpreter who understands the health care system.

*Question:*A nurse is caring for a post-operative Asian American client after knee arthroplasty. The nurse plans to help the client ambulate, but is aware that the client may feel threatened due to physical closeness. Why would be the most appropriate nursing action? A. Let the client ambulate slowly on his own when he is stable B. Instruct family members to ambulate the client C. Ambulate the client without answering his questions D. Explain the purpose and need for assistance during ambulation

Correct answer: *D* The nurse should explain the purpose of ambulation, and the need for assistance while ambulating, to the client. This would relieve his anxiety associated with physical closeness. However, the client won't be able to ambulate without assistance. Even though the nurse can instruct a family member to ambulate the client, this is not an appropriate action. Ambulating the client without answering the client's question is non-therapeutic, as the nurse would be preforming a procedure without giving adequate explanation.

*Question:*Upon moving to China, an American college student is experiencing many new feelings that she associates with her placement in a different culture. What are the feelings experienced by this student? A. Stereotyping B. Ethnocentrism C. Cultural assimilation D. Culture shock

Correct answer: *D* The student is experiencing culture shock, which is defined as the feelings a person experiences when placed in a different culture. Stereotyping is the assumption that all members of a culture, subculture, or ethnic group act alike. Ethnocentrism is the belief that one's ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. Cultural assimilation occurs when members of a minority group live within a dominant group and lose the cultural characteristics that make them different.

*Question:*An Arab client has been admitted to the health care facility with varicose veins. What should the nurse avoid while conducting the interview of the client? A. Giving a light handshake B. Asking about the client's medical history C. Asking about the client's personal life D. Maintaining eye contact

Correct answer: *D* While interviewing an Arab client, the nurse should avoid maintaining eye contact with the client. In Arab culture, maintaining eye contact is sexually aggressive; if the nurse does so during the interview, it may give the wrong message to the client. However, the nurse may give a light handshake or ask about the client's personal life and medical history during the interview.

*Question:*A nurse is caring for an Appalachian client following her hysterectomy. Which of the following Appalachian values and beliefs should be considered when planning nursing care? Select all that apply. A. Lifestyle is more revered than compliance with health care issues B. Isolation is considered a way of life C. They may be fatalistic about losses and deaths D. There is a deep love, respect, and between people and the land E. Dependence and self-determination are valued

Correct answers: *B C* In Appalachian population, isolation is considered as a way of life, independence and self-determination are valued, and they may be fatalistic about losses and deaths. In the Hawaiian population, lifestyle is more revered than compliance with health care issues; there is a deep love, respect, and affection between people and the land; and death is seen as part of life and not feared