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Chapter 05: Cultural Issues
MULTIPLE CHOICE
1.Culture is defined as a group’s shared:
| a. | race and ethnicity. |
| b. | values, beliefs, and norms. |
| c. | biologic variations and psychological characteristics. |
| d. | patterned behavioral responses that developed over time. |
ANS: B
Culture is the internal and external manifestation of a person’s, group’s, or community’s learned and shared values, beliefs, and norms that are used to help individuals function in life and understand and interpret life occurrences. None of the other responses provides an adequate explanation of culture, because all are too narrow in scope.
DIF:Cognitive level: UnderstandingREF:p. 50
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
2.A nurse begins work at an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after:
| a. | identifying culture-bound issues. |
| b. | implementing scientifically proven interventions. |
| c. | correcting inferior health practices of the population. |
| d. | exploring commonly held beliefs and values of the population. |
ANS: D
Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer.
DIF:Cognitive level: ApplyingREF:p. 50
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
3.A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge?
| a. | Knowledge is acquired through use of affective or feeling senses. |
| b. | Knowledge is acquired according to proof of existence. |
| c. | Knowledge develops by striving for transcendence of the mind and body. |
| d. | Knowledge evolves from an individual’s relationship with a supreme being. |
ANS: B
The European-American perspective of acquiring knowledge evolves through acquiring proof that something exists using the personal senses. The distracters describe the beliefs of other cultural groups.
DIF:Cognitive level: UnderstandingREF:p. 51
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
4.The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?
| a. | Patients of different cultural groups may metabolize medications at different rates. |
| b. | Metabolism of psychotropic medication is consistent among various cultural groups. |
| c. | Differences in hepatic enzymes will influence the rate of elimination of psychotropic medications. |
| d. | It is important to provide patients with oral and written literature about their psychotropic medications. |
ANS: A
Cytochrome P-450 enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates. Information about medication is important but does not apply to pharmacokinetics.
DIF:Cognitive level: UnderstandingREF:p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
5.A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine:
| a. | if the patient’s immunizations are current. |
| b. | the patient’s religious preferences. |
| c. | the patient’s specific ethnic group. |
| d. | whether or not an interpreter is needed. |
ANS: D
The assessment depends on communication. The nurse should first determine whether or not an interpreter is needed. The other information can be subsequently assessed when communication is effective.
DIF:Cognitive level: AnalyzingREF:p. 54
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
6.A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore:
| a. | chi. |
| b. | meridians. |
| c. | equilibrium. |
| d. | divine relationships. |
ANS: C
Patients who view illness as disequilibrium or lack of balance may seek alternative therapies to restore balance. Chi is an energy force. Meridians are lines in the body representing body functions. Divine relationships are an aspect of balance, but equilibrium is a broader concept.
DIF:Cognitive level: UnderstandingREF:p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
7.The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after:
| a. | ignoring the child. |
| b. | feeding the child warm foods. |
| c. | looking deeply into the child’s eyes. |
| d. | a root doctor or native healer intervenes. |
ANS: D
Individuals who believe in culture-bound illnesses usually also believe that the cure for the illness is found in treatment by a native healer or roots doctor. The parent would not believe that any of the other options are effective.
DIF:Cognitive level: ApplyingREF:p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
8.A Hispanic parent says, “An old woman gave my baby the evil eye.” The health care provider determines that the infant is physically healthy. The most culturally competent intervention would be to:
| a. | tell the parent that the baby is healthy and needs no treatment. |
| b. | explain that the evil eye is a superstition and not a cause of illness. |
| c. | encourage the parent to immerse the baby in cool water baths daily. |
| d. | bring a root doctor into the consultation to restore the baby’s lost soul. |
ANS: D
An individual who believes in mal ojo will also believe that Western medicine is ineffective to treat it. This person will believe that because the illness has an unnatural cause, treatment is best conducted by a native healer who can remove the spell. The parent would not view offering no treatment or casting doubt on evil eye as a superstition as helpful, making these options culturally insensitive. A cool water bath could destabilize an infant’s body temperature.
DIF:Cognitive level: AnalyzingREF:p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
9.A patient of Cuban descent is hospitalized with depression. Which factor is most applicable to care planning?
| a. | The nurse should confer with the family’s oldest woman, who will serve as the primary decision maker. |
| b. | With the patient’s permission, the nurse should consult with family and religious advisors to plan care. |
| c. | The plan of care should incorporate use of meditation and contemplation techniques. |
| d. | Western medical treatment will be readily accepted by the patient. |
ANS: B
Patients of Hispanic cultures often have relational worldviews. Individuals who have a relational worldview usually desire the involvement of family, religious advisors, and even friends during health care visits and the planning of interventions. The patient’s consent is required for this involvement. The other options reflect alternative worldviews.
DIF: Cognitive level: Applying REF: p. 53 TOP: Nursing process: Planning
MSC: NCLEX: Psychosocial Integrity
10.A clinic patient comes to an appointment carrying a baby. The nurse notes abrasions on the baby’s thighs and determines that skin scraping has been used. In an effort to use cultural negotiation, the nurse should:
| a. | encourage using less pressure during scraping to prevent abrasions and infections. |
| b. | show the parent how to use moxibustion rather than skin scraping. |
| c. | explain that skin scraping does not effectively treat illness. |
| d. | caution that the scraped skin can become infected. |
ANS: A
Cultural negotiation is the nurse’s ability to work within a patient’s cultural belief system to develop culturally appropriate interventions. Only by suggesting a modification of the technique of skin scraping so as to perform it in a manner that will not cause injury or the potential for infection can the nurse reflect cultural negotiation.
DIF:Cognitive level: ApplyingREF:p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Physiologic Integrity
11.A Hispanic patient says, “I have no energy and cannot eat. I want to sleep but can’t, because pain moves around different parts of my body.” A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing:
| a. | lost soul (susto). |
| b. | spiritual distress. |
| c. | a broken heart. |
| d. | amok. |
ANS: A
Loss of one’s soul, a culture-bound illness occasionally seen among Hispanic individuals, produces vague symptoms such as those described. Western medicine regards these as depressive symptoms, but individuals with lost soul speak only of physical symptoms, rather than psychological or emotional disequilibrium. The other options are culture-bound disorders with symptoms different from what is described in this scenario.
DIF: Cognitive level: Understanding REF: p. 53 TOP: Nursing process: Analysis
MSC: NCLEX: Psychosocial Integrity
12.A Hispanic patient reports symptoms consistent with the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with:
| a. | care from a traditional healer. |
| b. | acupuncture. |
| c. | skin scraping. |
| d. | moxibustion. |
ANS: A
The patient is probably experiencing lost soul, a culture-bound illness. Its symptoms are depressive in nature and might well respond to treatment with an antidepressant. However, because the individual sees the cause as loss of the soul, she will not have faith in medication as a cure. Using a traditional healer to return the lost soul will set the stage for medication to relieve symptoms. The other options are not culturally appropriate.
DIF: Cognitive level: Applying REF: p. 53 TOP: Nursing process: Planning
MSC: NCLEX: Psychosocial Integrity
13.A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse’s most appropriate initial intervention?
| a. | Ask if the parent has used coining. |
| b. | Report the parent for suspected child abuse. |
| c. | Assess whether or not the parent desires to harm the child. |
| d. | Ask if the parent has taken the child to an acupuncturist. |
ANS: A
Recognition of the characteristic marks of coining or skin scraping can keep the nurse from making a culturally insensitive judgment that child abuse is occurring. Coining is used by Asian families to restore equilibrium for babies and small children. The other options would be inappropriate or ineffective.
DIF:Cognitive level: ApplyingREF:p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
14.A parent said, “My child had mal ojo, so I did not give her the medicine for an ear infection.” The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse would analyze that the situation occurred because of:
| a. | lack of knowledge of therapeutic regimen. |
| b. | differences in perceptions of how illness occurs. |
| c. | evidence of unconscious hostility toward the child. |
| d. | a misunderstanding about the communicability of microbes. |
ANS: B
A parent who believes that his or her child’s illness is the result of a spell cast on him or her will not understand the need for giving the child medication on a regular basis for several days. Diagnosing noncompliance will not help resolve the problem. Cultural negotiation and repatterning will be necessary. The other options do not present viable explanations.
DIF:Cognitive level: UnderstandingREF:pp. 51, 53 Table
MSC: NCLEX: Psychosocial Integrity
15.A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools. Group sessions are short and concise. After the group session, the patients are most likely to believe that:
| a. | the nurse was uncaring. |
| b. | the session was effective. |
| c. | the teaching was efficient. |
| d. | they were treated respectfully. |
ANS: A
Hispanic individuals usually have a relational worldview. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task. An individual with a relational worldview would be unlikely to hold any of the other views.
DIF: Cognitive level: Analyzing REF: pp. 51-52 TOP: Nursing process: Evaluation
MSC: NCLEX: Psychosocial Integrity
16.A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which action should occur next?
| a. | Verify understanding by asking the patient to restate the information. |
| b. | Ask if the patient is willing to follow directions for medications. |
| c. | Reinforce cultural norms about eating hot and cold foods. |
| d. | Provide the information in written form to the patient. |
ANS: A
Many Asians and Asian-Americans believe that questioning an authority figure (nurse) would be disrespectful, so they do not ask for clarification when they do not understand directions for their treatment. Individuals of this culture are usually willing to comply once they understand. Written information may be provided later. Although hot and cold foods might be used by Asian-Americans, there is no evidence that this patient is interested in this therapy.
DIF: Cognitive level: Analyzing REF: p. 51 TOP: Nursing process: Evaluation
MSC: NCLEX: Psychosocial Integrity
17.A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with these consumers?
| a. | Silence is considered a social error. |
| b. | Touching is an accepted part of conversation. |
| c. | Important topics are always preceded by polite social conversation. |
| d. | Rules regarding roles and status are important and must be observed. |
ANS: D
Relationships are based on the idea that the Supreme Being is present in each person and that all persons must be valued and treated with dignity. This is particularly true of treatment received by tribal elders, healers, and others perceived to be in positions of importance. The other options are not consistent with the ecologic worldview.
DIF: Cognitive level: Applying REF: p. 52 TOP: Nursing process: Planning
MSC: NCLEX: Psychosocial Integrity
18.A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence?
| a. | Serve the patient a cold beverage at the beginning of the interview. |
| b. | Review Middle Eastern cultural values before the interview. |
| c. | Avoid offering to shake hands with the patient. |
| d. | Determine if a translator is available. |
ANS: B
Brushing up on Middle Eastern culture would be a sensitive action that might result in a lowering of barriers between the nurse and patient. It would not be necessary to serve beverages during the interview. A translator would probably not be needed if the patient is a college professor. Shaking hands with Middle Easterners is acceptable.
DIF:Cognitive level: ApplyingREF:pp. 51-52
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
19.An African-American patient tells a nurse with a European-American worldview, “There’s no sense talking. You wouldn’t understand because you live in a white world.” Select the nurse’s best response.
| a. | “Nurses are educated to care for people from all cultures. It is a required component of nursing education.” |
| b. | “It would be helpful if you described an example of something you think I would not understand.” |
| c. | “Your mental illness is causing you to view me with prejudice. We are all here to help you.” |
| d. | “Yes, I do understand. Everyone goes through the same experiences.” |
ANS: B
Having the patient speak in specifics rather than globally will help the nurse understand the patient’s perspective. This approach will help the nurse establish rapport with the patient. False reassurances will not facilitate communication with the patient.
DIF:Cognitive level: AnalyzingREF:p. 51
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
20.A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient’s self-esteem, but after 3 weeks the patient’s eye contact was unchanged. Select the accurate analysis of this scenario.
| a. | The patient’s poor eye contact indicated anger and hostility that did not resolve. |
| b. | The nurse should have assessed the patient’s culture before formulating this diagnosis and plan. |
| c. | Resolution of shame and guilt cannot be expected to occur in 3 weeks. The nurse should allow more time. |
| d. | The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye contact. |
ANS: B
The amount of eye contact a person engages in is often culturally determined. In some cultures eye contact is considered insolent, whereas in others eye contact is expected and valued. Korean-Americans often prefer not to engage in direct eye contact.
DIF: Cognitive level: Analyzing REF: p. 54 TOP: Nursing process: Evaluation
MSC: NCLEX: Psychosocial Integrity
21.When a Mexican-American woman and nurse interact, the patient often holds the nurse’s hand or links arms with the nurse. The nurse is uncomfortable with this behavior. Which analysis is most accurate?
| a. | The patient is using touch to make the nurse uncomfortable and manipulate the relationship based on that factor. |
| b. | An energy field disturbance has occurred. Touch rebalances the energy between the patient and nurse. |
| c. | The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. |
| d. | The patient is accustomed to and comfortable with touch, as are members of many Hispanic cultures. |
ANS: D
The most likely answer is that the patient’s behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are much less likely.
DIF: Cognitive level: Analyzing REF: pp. 51-52 TOP: Nursing process: Analysis
MSC: NCLEX: Psychosocial Integrity
22.At the time of discharge, a patient with a European-American worldview demands copies of all medical records. Which analysis most accurately explains the patient’s behavior? The patient:
| a. | continues to experience mistrust of the team’s truthfulness. |
| b. | is probably planning to see an attorney about poor care. |
| c. | values the written evidence of illness and treatment. |
| d. | probably wants to edit the records for accuracy. |
ANS: C
Members of European-American cultures have analytic worldviews and value information that is written because it lends proof. The distracters offer more remote reasons for the behavior.
DIF:Cognitive level: AnalyzingREF:pp. 51-52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1.Which questions should the nurse ask to determine an individual’s worldview? Select all that apply.
| a. | “What is more important: the needs of an individual or the needs of a community?” |
| b. | “How would you describe an ideal relationship between individuals?” |
| c. | “How long have you lived at your present residence?” |
| d. | “Of what importance are possessions in your life?” |
| e. | “Do you speak any foreign languages?” |
ANS: A, B, D
The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine whether the worldview of the individual is analytic, relational, community, or ecologic. Other follow-up questions would be needed to validate findings.
DIF:Cognitive level: ApplyingREF:pp. 51-52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
2.A nurse cares for patients who recently immigrated to the United States. The nurse would expect patients from which countries to hold relational worldviews? Select all that apply.
| a. | Germany |
| b. | Panama |
| c. | Mexico |
| d. | Ghana |
| e. | France |
ANS: B, C, D
Persons of Hispanic and African-American cultures often hold relational worldviews. Mexico and Panama are predominantly Hispanic cultures. Ghana is African. Immigrants from Germany and France (European countries) would more likely have analytic worldviews.
DIF:Cognitive level: UnderstandingREF:p. 52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
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