Chapter 5, Cultural Diversity

When providing nursing care to an African American individual, which of the following cultural factors should the nurse consider? A) Values and beliefs are often present oriented. B) Families are usually patriarchal. C) They possess weak religious affiliations. D) Families are highly competitive.

Ans: A Feedback: Cultural factors that should be considered when providing care to the African American family include the recognition that the family is usually matriarchal, values and beliefs are present oriented, there is strong family unity and cooperation, and families are frequently highly religious and highly respect the African American clergy.

When providing care on an Indian reservation, the nurse has prioritized assessments for diabetes and fetal alcohol syndrome when working with residents of the reservation. How should this nurse's practice be best understood? A) The nurse is correct in assessing for health problems that have a higher incidence and prevalence among this population. B) The nurse is stereotyping American Indians as leading unhealthy lifestyles and abusing alcohol. The nurse is performing cultural imposition of the majority American culture, and the accompanying beliefs around C) diabetes and alcohol use. D) The nurse should seek specific permission from each client before proceeding with these assessments.

Ans: A Feedback: Because diabetes and fetal alcohol syndrome are known to have a higher incidence and prevalence among American Indians, Nurse K. is justified in reflecting this objective reality during health assessment. This action is rooted in epidemiology, not the inaccurate generalization of stereotyping. Because the consequences of both problems are significant and objective, Nurse K. is not guilty of cultural imposition and specific permission for these assessments is not likely necessary.

The nurse is obtaining a health history from a patient of Puerto Rican descent. Which of the following is most likely to be a health problem that has a cultural connection for this patient? A) Lactose enzyme deficiency B) Tuberculosis C) Sickle cell anemia D) Suicide

Ans: A Feedback: Common health problems that may affect the Puerto Rican population include lactose enzyme deficiency and parasitic diseases. Tuberculosis is a common health problem for the Native American population. Sickle cell anemia predominantly affects the African American population, and suicide is a common health problem for the Native American and white middle-class populations.

Despite the presence of a large number of elderly residents of Asian heritage, a long-term care facility has not integrated the Asian concepts of hot and cold into meal planning. Which of the following should the nurses at the facility recognize this as an example of? A) Cultural blindness B) Stereotyping C) Cultural assimilation D) Cultural imposition

Ans: A Feedback: Cultural blindness is characterized by ignoring cultural differences or considerations and proceeding as if they do not exist. This phenomenon may underlie the failure to incorporate cultural considerations into dietary choices. Stereotyping assumes homogeneity of members of other cultures. Cultural assimilation involves the replacement of values with those of a dominant culture. Cultural imposition presumes that everyone should conform to a majority belief system.

A nurse walks by a client's room and observes a Shaman performing a healing ritual for the client. The nurse then remarks to a coworker that the ritual is a waste of time and disruptive to the other clients on the floor. What feelings is this nurse displaying? A) Culture conflict B) Cultural blindness C) Stereotyping D) Cultural shock

Ans: A Feedback: Culture conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values.Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Stereotyping is the assumption that all members of a culture, ethnic group, or race act alike. Culture shock refers to the feelings a person experiences when placed in a different culture that is perceived as strange.

The nurse is admitting a client from China to the medical-surgical unit with a diagnosis of cancer. While doing the client's assessments, the client speaks of her naturalistic beliefs related to health care and the importance of the yin/yang theory. Based on her cancer diagnoses, the idea that cancer is considered a cold illness in the culture, and her yin/yang beliefs, which meal will the patient most likely order for lunch? A) Chicken noodle soup with crackers, fruit crisp, and hot tea B) Turkey sandwich, small tossed salad, and iced tea C) Chef's salad, bread, and water D) Fruit smoothie and granola bar

Ans: A Feedback: In some Asian cultures, good health is thought to be achieved through the proper balance of yin (feminine, negative, dark, cold) and yang (masculine, positive, light, warm). Hot foods are eaten when a person has a cold illness, such as cancer, a headache, and stomach cramps. Based on this information, the patient would likely select chicken noodle soup with crackers, fruit crisp, and hot tea, as these are hot foods. The other options are cold foods and would more likely be eaten when a patient has a hot illness.

A nursing instructor has assigned a student to care for a client of Asian descent. The instructor reminds the student that personal space considerations vary among cultures. What personal space preferences are important for the student to consider when caring for this client? A) People of Asian descent prefer some distance between themselves and others. B) People of Asian descent commonly stand close to one another when talking. C) People of Asian descent touch one another when sitting next to a familiar person. D) People of Asian descent prefer direct eye contact when communicating.

Ans: A Feedback: Individuals of Asian descent are more comfortable with some distance between themselves and others. Direct eye contact may be considered impolite or aggressive within the Asian culture, and they may tend to avoid direct eye contact and avert their eyes while speaking with others.

All of the following are factors to consider when caring for clients with limited income. Which one is the most important? A) Basic human needs may go unmet B) Limited access to reliable transportation C) Decreased access to health care services D) Risk for increased incidence of disease

Ans: A Feedback: Poverty prevents many people from consistently meeting their basic human needs. Limited means of transportation, decreased access to health care services, and an increased incidence of disease are also influenced by limited income, but meeting one's basic human needs is the most important factor.

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance? A) Know the client's cultural personal space preferences. B) Realize that sitting close to the client is an indication of warmth and caring. C) Sit three to six feet away from the patient in an attempt to not offend. D) Remember not to intrude into the personal space of the elderly.

Ans: A Feedback: When providing nursing care that involves physical contact, you should know the client's cultural personal space preferences. Sitting close to, or too far away from, the patient may be interpreted as offensive. Age is not necessarily a deciding factor in regards to a person's cultural practices.

What is the term that describes the inability of a person to recognize his or her own values, beliefs, and practices as well as those of others, because of strong ethnocentric tendencies? A) Acculturation B) Cultural blindness C) Cultural imposition D) Stereotyping

Ans: B Feedback: Cultural blindness occurs when one ignores differences and proceeds as though they do not exist, resulting in bias and stereotyping. Acculturation is the process by which members of a culture adapt or learn how to take on the behaviors of another group. Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Stereotyping is when one assumes that all members of a culture, ethnic group, or race act alike.

A Mexican immigrant who migrated to the United States and lives in a Spanish-speaking community with other relatives is taken to the ER following a fall at work. He is admitted to the hospital for observation. The nurse is aware tht this client is at risk for: A) Cultural assimilation B) Cultural shock C) Cultural imposition D) Cultural blindness

Ans: B Feedback: Culture shock refers to the feelings 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 behavior 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 then feel foolish, fearful, incompetent, inadequate, or humiliated.

A 40-year-old nurse is taking a health history from a Hispanic man aged 20 years. The nurse notes that he looks down at the floor when he answers questions. What should the nurse understand about this behavior? A) The client is embarrassed by the questions. B) This is culturally appropriate behavior. C) The client dislikes the nurse. D) The client does not understand what is being asked.

Ans: B Feedback: Eye contact is one of the most culturally variable forms of communication. Although Americans emphasize eye contact while speaking, Hispanics look downward in deference to age, gender, social position, economic status, and authority.

The nurse caring for a Native American client plans care understanding that one belief of Native American healing practices is which of the following? A) Modern life facilitates healing agents. B) Healing takes time. C) Balancing yin and yang is important. D) Energy flows through meridians throughout the body.

Ans: B Feedback: Native American healing practices are grounded in their cultural views. One concept, identified in a study, is that healing takes time.

A male nurse is preparing to take the vital signs of a female patient. Which ethnic group would consider this improper? A) Native American B) Arab Muslim C) White D) African American

Ans: B Feedback: The Islamic religion does not allow the use of health care professionals of the opposite gender unless it is impossible to locate one of the same gender. Native Americans, Caucasians, and African Americans do not necessarily share this sentiment.

A client who has difficulty sleeping expresses to the nurse that watching television may help him relax and get sleep. The nurse disregards the client's concern and suggests drinking warm milk before going to bed. Which cultural characteristic is the nurse demonstrating? A) Stereotype B) Ethnocentrism C) Racism D) Relativity

Ans: B Feedback: The nurse disregarding the client's concern is an example of ethnocentrism. Ethnocentric people view one's own culture as the only correct standard by which to view people of other cultures. Stereotypes are preconceived and untested beliefs about people. Racism uses skin color as the primary indicator of social value. Understanding that cultures relate differently to the same given situation is called relativity.

A nurse is caring for a client after internal fixation of a compound fracture in the tibia. The nurse finds that the client has not had his dinner, seems restless, and is tossing on the bed. Keeping in mind that the client is Latino, what is the most appropriate response by the nurse? A) Are you having pain in your leg? B) Tell me what you are feeling. C) Do you need pain medication? D) Are you feeling all right?

Ans: B Feedback: The nurse should ask the client what he is feeling. Asking open-ended questions would encourage the client to verbalize his pain. Latino men may not demonstrate their feelings or readily discuss their symptoms because they may interpret doing so as being less than manly. Closed-ended questions like Are you having pain?; Do you need pain medication?; and Are you feeling all right? may block communication and the client may not express his feelings.

An Asian American male client is operated on for gallstones. On the postoperative night, the nurse finds that the client is not sleeping and is tossing and turning. When asked about analgesics, the client expresses that he does not have pain. What nursing action is most appropriate? A) Believing that the client has no pain B) Assessing for non-verbal expressions of pain C) Inspecting the incision site for any abnormality D) Asking the client if he is feeling hungry

Ans: B Feedback: The nurse should be aware that in Asian American culture, men tend to control their emotions and expressions of physical discomfort. Keeping this in mind, the nurse should assess the client for non-verbal expressions of pain. The nurse should not believe the client when he says that he does not have pain because, after surgery, pain is likely to occur. The nurse may inspect the incision site, but it is not an appropriate action. Asking the client if he is hungry may be irrelevant.

A nurse in a large metropolitan city enjoys working in a health clinic that primarily serves Hispanic clients. What does this statement imply about the nurse? A) The nurse's knowledge and skills are not adequate to care for clients with acute illnesses. B) The nurse respects and values providing culturally competent care. C) The nurse is attempting to overcome cultural blindness. D) This employment makes the nurse feel superior to a minority group of people.

Ans: B Feedback: The nurse who recognizes and respects cultural diversity has cultural sensitivity, avoids cultural imposition and ethnocentrism, and provides nursing care that accepts the significance of cultural factors in health and illness.

A nurse is providing care for a Cambodian client. The nurse says, "You have to get up and walk whether you want to or not." What is this statement an example of? A) Culture shock B) Stereotyping C) Cultural imposition D) Cultural competence

Ans: C Feedback: Cultural imposition is the tendency for health care personnel to impose their beliefs, practices, and values on people of other cultures because they believe their ideas are superior. When health care professionals assume they have the right to make decisions for clients, the clients often respond by becoming passive, angry, or resistant to treatment.

The nurse is caring for a Mexican American who is Catholic. The nurse wishes to learn more about the culture by consulting a key informant. Which of the following religious practitioners would be most knowledgeable about the beliefs held by individuals of Mexican ethnicity? A) A church mother B) A voodoo priest C) A curandera D) A peyote leader

Ans: C Feedback: For Mexican Americans who are Roman Catholic, the priest and the curandera (a secular folk healer) may be useful informants.

The nurse is providing home care for a client who traditionally drinks herbal tea to treat an illness. How should the nurse respond to a request for the herbal tea? A) We do not allow our clients to drink herbal tea. B) Why in the world would you want to drink that stuff? C) Let me check with the doctor to make sure it is okay to drink the tea with your medicines. D) I have to fill out a lot of forms that you will have to sign before I can do that.

Ans: C Feedback: Herbs are a common method of treatment in many cultures. If a client traditionally drinks an herbal tea to alleviate symptoms of an illness, there is no reason why both the herbal tea and the prescribed medications cannot be used as long as the tea is safe to drink and does not interfere with, or exaggerate, the action of the medications. Asking why the patient would want to drink "that stuff" is demeaning to the patient. Answer d is incorrect because there is no paperwork necessary.

When the South Asian client arrives 25 minutes late to her appointment at the clinic, the nurse recognizes this as a sign of which of the following? A) Disrespect B) Laziness C) Respect D) Superiority

Ans: C Feedback: In some South Asian cultures, being late is considered a sign of respect. It may be useful to note this in the client's file and take it into account when scheduling future appointments.

The nurse is admitting a new client to the unit. The nurse notes that this client would need an alternate meal choice when the menu specified pork for a meal. What cultural group would require an alternative meal choice? A) Christian B) Protestant C) Muslim D) Mormon

Ans: C Feedback: Many Muslim people abstain from eating pork.

A nurse in the hospital is caring for a Native American male. What person is most important to include in the care of the client? A) Family B) Physician C) Tribal medicine man D) Physical therapy aide

Ans: C Feedback: Observance of rituals in times of stress and uncertainty helps to restore a sense of control, competence, and familiarity; to that extent, these rituals are a desirable adjunct to nursing care.

An older adult woman of Chinese ancestry refuses to eat at the nursing home, stating, "I'm just not hungry." What factors should the staff assess for this problem? A) The woman does not like to eat with other residents of the home. B) The woman is using this as a means of going home. C) The food served may not be culturally appropriate. D) The food served may violate religious beliefs.

Ans: C Feedback: Residents in long-term care settings often do not have much choice of foods. As a result, they may not be able to select cultural food preferences. When assessing the cause of decreased appetite in clients, the nurse should determine whether the problem may be related to culture.

A nurse engages in professional rituals as a means to standardize practice and ensure efficiency. In doing so, the nurse integrates understanding of which of the following as a characteristic? A) Preconceived and untested belief about people B) Viewing one's own culture as the only correct standard C) Common and observable expressions of culture D) Belief system held to varying degrees as absolute truth

Ans: C Feedback: Rituals are common and observable expressions of culture. A preconceived and untested belief about people is called a stereotype. Viewing one's own culture as the only correct standard is ethnocentrism. A belief system held to varying degrees as absolute truth is referred to as culture.

The focal point of nursing is the nurse-client interaction. What must nurses consider when conducting the necessary assessment of their clients and significant others? A) Their health disparities B) Their societal beliefs C) The subgroup they belong to D) Their own cultural orientation.

Ans: D Feedback: Because the nurse-client interaction is the focal point of nursing, nurses should consider their own cultural orientation when conducting assessments of patients and their families and friends. Although nursing as a whole is actively recruiting more diverse members, many nurses are members of, and have the same value systems as, the dominant middle-class structure in the United States.

A nurse is caring for an elderly woman from a far eastern culture. How does the nurse demonstrate awareness of culturally competent care? A) Maintaining eye contact at all times. B) Trying to speak louder than usual. C) Using touch when communicating. D) Establishing effective communication.

Ans: D Feedback: Establishment of an environment of culturally competent care and respect begins with effective communication, which occurs not only through words, but also through body language and other cues, such as voice, tone, and loudness. Maintaining eye contact at all times is incorrect because not all cultures are comfortable with eye contact; speaking louder is incorrect because the issue is a communication problem, not a hearing problem; not all cultures are comfortable with touch so this would block communication.

Most nurses have been taught to maintain direct eye contact when communicating with clients. Some cultural groups would not value direct eye contact with the nurse. Which cultural group would consider the direct eye contact impolite? A) Americans B) British C) Canadians D) Native Americans

Ans: D Feedback: Eye contact is also a culturally determined behavior. Although most nurses have been taught to maintain eye contact when speaking with patients, some people from certain cultural backgrounds may interpret this behavior differently. For example, some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians may consider direct eye contact impolite or aggressive, and they may avert their eyes when talking with nurses and others whom they perceive to be in positions of authority.

A nurse is caring for a client from Taiwan who constantly requests pain medication. What should the nurse consider when assessing the client's pain? A) Most people react to pain in the same way. B) Pain in adults in less intense than pain in children. C) The client has a low pain tolerance. D) Pain is what the client says it is.

Ans: D Feedback: Pain is what the client says it is, and nursing care should always be individualized. The nurse respects the client's right to respond to pain in whatever manner is culturally and individually appropriate and never stereotypes a client's perceptions or responses to pain. Pain tolerance is subjective: again, the client's pain is what she says it is.

When a labor and delivery nurse tells a coworker that an Asian client probably did not want any pain medication because "Asian women typically are stoic," the nurse is expressing a belief known as what? A) Stigma B) Ethnic slur C) Bias D) Stereotype

Ans: D Feedback: Stereotypes are preconceived and untested beliefs about people. Ethnic slur refers to a statement made about another according to their ethnicity; stigma refers to social disapproval; bias refers to an inability to view someone or something without being objective.

The client in a rehabilitation unit is having a difficult time adjusting to the scheduled activities on the unit, as well as being dependent on others for meals and medications. Which word best describes what the patient is experiencing? A) Anxiety B) Disparity C) Resolution D) Shock

Ans: D Feedback: The acute experience of not comprehending the culture in which one is situated is called culture shock. This is often experienced by a client who suddenly finds himself or herself in the subculture of a hospital or health care agency.

A home health nurse is visiting a client 60 years of age. During the initial visit, the client's husband answers all of the questions. What would the nurse assess based on this behavior? A) The client does not want the nurse to visit. B) The husband does not trust his wife to answer questions. C) The cltient is not able to answer the questions. D) The husband is the dominant member of the family.

Ans: D Feedback: To provide culturally competent care, the nurse must take into consideration the role of the family member who makes most decisions. To disregard this fact or to proceed with nursing care that is not approved by this person can result in conflict or disregard for what is being taught.

A father, mother, grandmother, and three school-aged children have immigrated to the United States from Thailand. Which member(s) of the family are likely to learn to speak English more rapidly? A) Unemployed father B) Stay-at-home mother C) Grandmother D) Children

Ans: D Feedback: When people from another part of the world move to the United States, they may speak their own language fluently but have difficulty speaking English. This is especially true for women, older adults, and those who are unemployed. Children usually assimilate more rapidly and learn the language more quickly because they go to school each day and make new friends in the dominant culture.

An Anglo American client reports to the primary health care facility with symptoms of fever, cough, and running nose. While interviewing the client, which of the following points should the nurse keep in mind? A) Do not probe into emotional issues. B) Do not ask very personal questions. C) Sit at the other corner of the room. D) Maintain eye contact while talking.

Ans: D Feedback: While interviewing an Anglo-American client, the nurse should maintain eye contact, because it indicates openness and sincerity. Anglo-Americans freely express positive and negative feelings; therefore, the nurse may probe into emotional issues. Anglo-American culture is an open culture, and members of this culture don't mind providing personal information. Also, Anglo-Americans are not threatened by closeness, so the nurse may not have to sit in another corner of the room.