Chapter 15 WOK Culture & Ethnicity

____ 1. North American healthcare culture typically reflects which culture? 1) Asian 2) European American 3) Latino 4) African American

2) european american In North America, the healthcare culture reflects the dominant, or European American, culture.

19. The nurse prepares to assess a client from a non-English-speaking culture. Which question should the nurse include to assess language? 1) "Who is in your family?" 2) "How long have you lived here?" 3) "Who makes most of the decisions?" 4) "Are you comfortable speaking English?"

ANS: 1 1 "Who is in your family?" assesses family roles. 2 "How long have you lived here?" assesses where the client was raised. 3 "Who makes most of the decisions?" assesses family roles. 4 To assess language, the nurse should ask, "Are you comfortable speaking English?"

17. The mother of a 15-year-old Mexican female is excited about planning the daughter's quinceañera. With which cultural term should the nurse identify this event? 1) Specific 2) Universal 3) Stereotype 4) Archetype

ANS: 1 1 Culture specifics are those values, beliefs, and practices that are special or unique to a culture. 2 Culture universals are the values, beliefs, and practices that people from all cultures share. 3 A cultural stereotype is an unsubstantiated belief that all people of a certain racial or ethnic group are alike in many respects. 4 A cultural archetype is a symbol for remembering some of the culture specifics and is usually not negative.

18. A client from a non-American culture says that to maintain health there needs to be a balance between the body and nature. Which health belief system does this client follow? 1) Holistic 2) Scientific 3) Biomedical 4) Magico-religious

ANS: 1 1 The holistic belief system focuses on the need for harmony and balance of the body with nature. 2 The scientific health system is the model practiced in the United States and relies on the scientific method. 3 The biomedical health system is the model practiced in the United States and utilizes medications and other therapies to treat health problems. 4 In the magico-religious system, belief in supernatural (mystical) forces dominates. This system is considered "alternative" or "indigenous" in the United States.

14. A patient reports experiencing gas, abdominal bloating, and diarrhea after consuming milk or cheese. Lactose intolerance might immediately be suspected if the patient is of which heritage? 1) African American 2) Mexican American 3) European American 4) Arab American

ANS: 1 Lactose intolerance, caused by a deficiency of the enzyme lactase, is more commonly seen in African Americans.

A patient of Scandinavian heritage is admitted for observation after sustaining injuries in a motor vehicle accident. The nurse expects that he may endure pain stoically, without grimacing or vocalizing. Of what is the nurse's thinking an example? 1) Archetype 2) Bias 3) Prejudice 4) Stereotype

ANS: 1 1 An archetype is an example of a person or thing—something that is recurrent—and it has its basis in facts. Therefore, it becomes a symbol for remembering some of the cultural specifics and is usually not negative. 2 A bias is the tendency to see only one side of an issue, a lack of impartiality. 3 Prejudice refers to negative attitudes toward other people that are based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on. 4 A cultural stereotype is the unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects.

12. A patient of Hispanic origin is frustrated because the healthcare team does not understand the importance of hot and cold therapies. Which nursing diagnosis is most appropriate for this patient? 1) Powerlessness 2) Impaired Verbal Communication 3) Spiritual Distress 4) Risk for Noncompliance

ANS: 1 1 Powerlessness is the best nursing diagnosis for the patient who is unable to make healthcare personnel understand the importance of his cultural beliefs. 2 Impaired Verbal Communication can be used for patients who do not speak or understand the healthcare personnel's language. 3 Spiritual Distress might occur because a treatment is not in agreement with the patient's religious beliefs. 4 Risk for Noncompliance can be identified when a patient fails to follow a health-promoting or therapeutic plan the healthcare provider believes he agreed to.

6. Which is considered a "practice"? 1) Always drinking water after exercise 2) Thinking often about cleanliness 3) Emphasizing success 4) Maintaining youth

ANS: 1 A practice is a set of behaviors that one follows, such as always drinking water after exercise. 1 A practice is a set of behaviors that one follows, such as always drinking water after exercise. 2 Thinking about cleanliness is a value. 3 Emphasizing success is a value. 4 Maintaining youth is a value.

4. The nurse collects biographical information on a client from Central America. Which information provided by the client represents ethnicity? 1) Latino 2) Catholic 3) White 4) Teacher

ANS: 1 Ethnicity refers to groups whose members share a common cultural heritage. This patient came from a Spanish-speaking country in Central America; therefore, ethnicity is considered Latino.

23. The nurse prepares a paper on the traditional American healthcare culture to submit for publication. What should the nurse include as values of this culture? Select all that apply. 1) Significance of technology 2) Desire to conquer disease 3) Uses the problem-solving method 4) Reliance on the biomedical system 5) Defines health as absence of disease

ANS: 1, 2, 4, 5 1. Values of the traditional American healthcare system include the significance of technology. 2. Values of the traditional American healthcare system include a desire to conquer disease. 4. Values of the traditional American healthcare system include relying on the biomedical system. 5. Values of the traditional American healthcare system include defining health as the absence or minimization of disease.

20. Which statement about culture is true? Select all that apply. 1) Culture exists on both material and nonmaterial levels. 2) Culture mainly influences food choices and special holidays. 3) Cultural customs change over time at different rates. 4) Culture is learned through life experiences shared by other cultural members. 5) Cultural assumptions and habits are unconscious.

ANS: 1, 3, 4, 5 1 Culture exists at many levels that are both material and nonmaterial. 2. Culture is all encompassing and affects everything its members think and do; it is not limited to food and holidays. Although those are visible manifestations of a culture, dietary practices and cultural calendars are not the essence of true and meaningful culture. 3. Cultural customs, beliefs, attitudes, and practices are not static but change over time at different rates, depending on current events, other significant people, and social influences. 4. Culture is learned through life experiences that are shared by other members of the culture, such as family members, those sharing similar religious beliefs, and people of similar cultural heritage in the same community. 5. Cultural assumptions and habits are unconscious. Thus, they may be difficult for members of the culture to explain to others or to identify as different from those of another culture.

3. A middle-aged Chinese American client, who is self-employed without health insurance, is recovering from heart surgery. Each day family members spend hours at the client's bedside. Which is the most important factor for the nurse to focus on when planning the client's discharge? 1) Ethnic background 2) Family support 3) Employment status 4) Healthcare coverage

ANS: 2 1 Although the client's ethnic background is very important to care, discharge planning should revolve around available resources. 2 The nurse should focus on the patient's strengths and resources for health restoration and self-care. In this case, it is the client's family. 3 Employment status is not an issue. 4 Insurance should not be the focus at this time, although at some point the nurse has probably obtained data about this topic.

16. The nurse assesses a client from a non-English-speaking culture. Why should the nurse avoid using the term minority when asking this client about ethnicity and race? 1) It represents power. 2) It suggests inferiority. 3) It is the group with the most authority. 4) It explains how everyone else is inferior.

ANS: 2 1 A dominant culture is the group with the most power to control values and behaviors. 2 The term minority is sometimes used to refer to a group of people who receive different and unequal treatment from others in society. You should consider that this term could be offensive to some because it suggests inferiority and marginalization. 3 The dominant culture is the group with the most authority. 4 The dominant group may assume their ways are the norm and that everyone else is culturally different.

7. The nurse is caring for a client who emigrated from Puerto Rico. What should the nurse learn to best care for this client? 1) Practices of the patient's ethnic group 2) Patient's individual cultural beliefs 3) Values of her own culture 4) Spanish-speaking community

ANS: 2 1 It is helpful to become familiar with the patient's ethnic group; however, the nurse should not assume that the individual holds the same values and beliefs and adheres to the same practices as the ethnic group. 2 The nurse cares for this patient by becoming familiar with the patient's individual cultural and ethnic beliefs and values. 3 The nurse should explore her own culture but not assume that the patient holds those same beliefs and adheres to the same practices. 4 It is helpful to become familiar with the Spanish-speaking community; however, the nurse should not assume that the individual holds the same values and beliefs and adheres to the same practices as the community.

11. A patient who has not voided for several hours is prescribed an indwelling urinary catheter. How should the nurse explain the procedure to the patient? 1) "I need to put a Foley in you because you haven't voided since your surgical procedure." 2) "I need to insert a tube into your bladder to drain the urine because you haven't urinated since surgery." 3) "I need to catheterize you because you haven't urinated since having your surgery." 4) "I need to place a catheter in your bladder because you haven't voided since surgery."

ANS: 2 1 Medical jargon such as Foley should be avoided. 2 "I need to insert a tube into your bladder . . ." best describes the procedure for the patient because the explanation is in terms most patients will understand. 3 Medical jargon such as catheterize should be avoided. 4 Medical jargon such as void should be avoided.

15. A client's mother was Chinese and the father was Samoan and Filipino. What should the nurse do when assessing this client's race? 1) Document the mother's race as the client's race. 2) Ask with which race the client most closely identifies. 3) Document the father's primary race as the client's race. 4) Document both of the father's races as the client's race.

ANS: 2 Culturally sensitive nurses ask people with what race they identify and what name they prefer to use for it. 1 The nurse needs to ask the client with what race he identifies. 2 Culturally sensitive nurses ask people with what race they identify and what name they prefer to use for it. 3 The nurse needs to ask the client with what race he identifies. 4 The nurse needs to ask the client with what race he identifies

21. The nurse is caring for a patient of Japanese heritage who refuses pain medication despite the nurse's explaining its importance in the healing process. Which intervention by the nurse is appropriate for this patient? Select all that apply. 1) Assess the patient's pain levels at less frequent intervals. 2) Document in the patient's record that the patient does not want to take opioids. 3) Utilize nonpharmacological measures to help control the patient's pain. 4) Notify the primary care provider of the patient's noncompliance. 5) Provide the medication without telling the patient.

ANS: 2, 3 2. The nurse should document that the patient wishes to avoid opioid use in the nurses' notes. 3. When the patient continues to refuse pain medications despite explanation, the nurse should respect the patient's wishes and utilize nonpharmacological measures to control pain.

22. The staff development trainer creates a program on culture for a group of new nurses. What should be included about vulnerable populations? Select all that apply. 1) Vulnerable populations exist primarily in minority groups. 2) People in a vulnerable population have limited access to healthcare. 3) Individuals in vulnerable groups are more likely to have health problems. 4) Examples of vulnerable populations include the poor, very young, and very old. 5) A person in a vulnerable population is more prone to engage in high-risk behaviors.

ANS: 2, 3, 4, 5 2. Vulnerable populations are groups that are more likely to have limited access to healthcare. 3. Vulnerable populations are groups that are more likely to develop health problems. 4. Vulnerable populations include the poor, very young, and very old. 5. Vulnerable populations are groups that are more likely to engage in high-risk behaviors.

24. A client who does not speak English needs extensive care. What resources are available to maximize communication with this client? Select all that apply. 1) U.S. embassies 2) Bilingual staff 3) Telephone interpreters 4) Client's family members 5) Face-to-face interpreters

ANS: 2, 3, 5 2. Healthcare facilities must provide language assistance through bilingual staff. 3. Healthcare facilities must provide language assistance through telephone interpreters. 5. Healthcare facilities must provide language assistance through face-to-face interpreters.

5. A patient from Italy has lived in the United States for years and practices elements from both cultures. What is this patient demonstrating? 1) Assimilation 2) Socialization 3) Acculturation 4) Immigration

ANS: 3 1 Cultural assimilation occurs when the new member gradually learns and takes on, to a great extent, the dominant culture's values, beliefs, and behaviors. 2 Socialization is the process of learning to become a member of a society or group. 3 Acculturation is a learning process through which immigrants (new members of a group or country) assume the characteristics of that culture. A person who is acculturated accepts both his own and the new culture, adopting or adapting elements of each. 4 Immigration is the act of moving to a new country.

10. An older client asks for another nurse because of not wanting a "man" to provide her with care. Which cultural barrier is this client exhibiting? 1) Ethnocentrism 2) Racism 3) Sexism 4) Chauvinism

ANS: 3 1 Ethnocentrism occurs when a person is positively biased toward her own culture. 2 Racism is a form of prejudice and discrimination based on race. 3 This patient is exhibiting sexism; she is objecting to the nurse merely because of his sex. Although we tend to think of sexism in a negative light, this woman may merely be reflecting a cultural attitude. The patient is in no position to actually discriminate against the nurse in terms of employment and so on. 4 Chauvinism occurs when a person assumes that he is superior.

8. The nurse is teaching a clinic patient about hypertension. Which statement indicates the patient is present oriented? 1) "I know I need to lose weight; I'll have to begin an exercise program right away." 2) "If I change my diet and begin exercising, maybe I can control my blood pressure without medications." 3) "I know I need to give up foods that contain a lot of salt, but with teenagers in the house it is very difficult." 4) "I will reduce the amount of calories, salt, and fat that I eat; I certainly do not want to have a stroke."

ANS: 3 1 Losing weight and beginning to exercise are future oriented because they indicate that the patient is planning lifestyle changes that will affect the future. 2 Changing diet and beginning to exercises are future oriented because they indicate that the patient is planning lifestyle changes that will affect the future. 3 Knowing an action is needed but giving reasons for not beginning it "just now" shows a focus on the present. The patient knows that he should reduce his sodium intake, but his present situation is preventing him from doing so. Therefore, he is disregarding the impact consuming sodium might have on his future. 4 Reducing the intake of calories, salt, and fat is future oriented because doing so indicates that the patient is planning lifestyle changes that will affect the future.

A young adult male client of Mexican heritage sustains injuries from a motor vehicle crash. When assessing this patient, the nurse must consider that the client may possess which view of pain? 1) A belief in taboos against narcotic use to relieve pain 2) Expectation of immediate treatment for relief of pain 3) Endurance of pain longer and report it less frequently than some patients do 4) Use of herbal teas, heat application, and prayers to manage his pain

ANS: 3 Endurance of pain longer and report it less frequently than some patients do 1 Patients of Japanese heritage may have taboos against narcotic use to relieve pain. 2 Expecting pain to be immediately relieved is not an archetype of any particular cultural group. 3 In general, patients of Mexican heritage may endure pain longer and report it less frequently than others. 4 Patients of Puerto Rican heritage may use herbal teas, heat application, and prayers to manage pain.

9. A client incorporates alternative healthcare into regular health practices. For which alternative therapy should the patient visit a formally trained practitioner? 1) Use of herbs and roots 2) Application of oils and poultices 3) Burning of dried plants 4) Acupuncture

ANS: 4 1 Use of herbs and roots does not require a formally trained practitioner. 2 Applying oils and poultices does not require a formally trained practitioner. 3 Burning dried plants does not require a formally trained practitioner. 4 Acupuncture requires a formally trained practitioner.

____ 9. A patient of Japanese heritage avoids asking for narcotics for pain relief. The nurse writes a nursing diagnosis of Pain related to reluctance to take medication secondary to cultural beliefs. If the cultural archetype is true for this particular patient, this probably means that the patient views pain as

a virtue and matter of family honor

____ 3. The nurse is caring for a 42-year-old Chinese American patient who underwent emergency coronary artery bypass graft surgery. He is self-employed and has no health insurance. Each day members of his family spend hours at his bedside. Which is the most important factor for the nurse to focus on when planning the patients discharge?

family support

____ 10. The nurse is developing a plan of care for a patient of Aleut descent who sustained a hip fracture. Which intervention by the nurse recognizes the patients indigenous healthcare system and should be included in the plan of care?

scheduling a visit from the shaman