Chapter 9: Culture and Ethnicity

Test Bank
MULTIPLE CHOICE
1. Despite significant improvements in the overall health status of the U.S. population over the
past few decades, disparities among ethnic and racial minorities have
a
.
Decreased as education levels equal those of non-Hispanic whites.
b
.
Disappeared in relation to non-Hispanic white populations.
c
.
Remained a serious challenge locall and nationall.
d
.
Decreased faster than anticipated.
!"S# $
Despite significant improvements in the overall health status of the U.S. population over the
past few decades, the persistence of disparities in health status among ethnic and racial
minorities continues to be a serious local and national challenge. Hispanics, !frican
!mericans, and some !sian subgroups are less li%el than non-Hispanic whites to have a high
school education and often e&perience poorer access to care and lower qualit of preventive,
primar, and specialt care.
D'(# Remember R)(# 1*1
+,-# Describe social and cultural influences in health, illness, and caring patterns.
.+/# !ssessment 0S$# "ursing /rocess
1. )liminating disparities in the health status of people from diverse racial, ethnic, and cultural
bac%grounds has become one of the two most important priorities of Healthy People 2020
because populations with health disparities have
a
.
'ncreased incidence of disease.
b
.
2ower levels of morbidit.
c
.
2ower mortalit rates.
d
.
Decreased incidence of disease.
!"S# !
/opulations with health disparities have a significantl increased incidence of disease or
increased morbidit and mortalit when compared with the general population.
D'(# Understand R)(# 1*1-1*1
+,-# Describe social and cultural influences in health, illness, and caring patterns.
.+/# !ssessment 0S$# "ursing /rocess
3. !ccording to the +ffice of 0inorit Health 4+0H5, the thoughts, communications, actions,
customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups are
%nown as
a
.
$ulture.
b
.
Subculture.
c
.
)thnicit.
d
.
$ultural bac%lash.
!"S# !
.he +0H describes culture as the thoughts, communications, actions, customs, beliefs,
values, and institutions of racial, ethnic, religious, or social groups. Subcultures represent
various ethnic, religious, and other groups with distinct characteristics from the dominant
culture. )thnicit refers to a shared identit related to social and cultural heritage such as
values, language, geographical space, and racial characteristics. $ultural bac%lash occurs
when an individual re6ects a new culture because e&perience with a new or different culture is
e&tremel negative.
D'(# Remember R)(# 1*1
+,-# Differentiate culturall congruent from culturall competent care.
.+/# !ssessment 0S$# "ursing /rocess
7. 8hen as%ed to describe the differences between ethnicit and race, what should the student
nurse e&plain9
a
.
)thnicit refers to a shared identit, whereas race is limited to biological
attributes.
b
.
)thnicit and race are actuall the same and are based in cultural norms.
c
.
)thnicit can be understood onl through an ethic worldview.
d
.
Race refers to a shared identit, whereas ethnicit is limited to biological
attributes.
!"S# !
)thnicit refers to a shared identit related to social and cultural heritage such as values,
language, geographical space, and racial characteristics. )thnicit is different from race,
which is limited to the common biological attributes shared b a group such as s%in color or
blood tpe. 'n an intercultural encounter, there is an insider or native perspective 4ethic
worldview5 and an outsider:s perspective 4ethic worldview5. )thnicit is best understood b
those who are a part of that ethnicit and have an ;emic< worldview.
D'(# Understand R)(# 1*1
+,-# Differentiate culturall congruent from culturall competent care.
.+/# !ssessment 0S$# "ursing /rocess
=. $are that includes the nurse learning about cultural issues involved in the patient:s health care
belief sstem and enable patients and families to achieve meaningful and supportive care is
%nown as
a
.
)thnocentrism.
b
.
$ulturall competent care.
c
.
$ultural imposition.
d
.
$ulturall congruent care.
!"S# ,
.he goal of transcultural nursing is culturall congruent care, or care that fits the person:s
valued life patterns and set of meanings. $ulturall competent care reflects the abilit of a
nurse to bridge cultural gaps in caring and enables patients and families to achieve meaningful
and supportive caring. 't is a step toward reaching culturall congruent care. )thnocentrism is
a tendenc to hold one:s own wa of life as superior to those of others. 't is the cause of biases
and pre6udices. $ultural imposition is the use of one:s own values and lifestles as the
absolute guide in dealing with patients and interpreting behaviors.
D'(# Remember R)(# 1*3
+,-# Describe steps toward developing cultural competence. .+/# !ssessment
0S$# "ursing /rocess
>. .he nurse is caring for a "ative !merican who has had recent surger. 'n the patient:s culture,
it is a sign of wea%ness to complain of pain. 'n the nurse:s culture, people who are having pain
as% for pain medicine. .he nurse has assumed that the patient has not been having pain and
does not need medication because he has not complained of pain. 8hat is the nurse doing9
a
.
Utili?ing cultural imposition b not as%ing the patient about his pain
b
.
Striving to provide culturall congruent care b allowing the patient to suffer
c
.
+perating from an emic worldview of the patient:s cultural beliefs
d
.
/racticing discrimination b not giving the patient pain medicine
!"S# !
Health care practitioners who have cultural ignorance or cultural blindness about differences
generall resort to cultural imposition and use their own values and lifestles as the absolute
guide in dealing with patients and interpreting their behaviors. $ulturall competent care is
the care provided b the nurse who attempts to bridge cultural gaps in caring, wor% with
cultural differences, and enable patients and families to achieve meaningful and supportive
caring. .he nurse in this case has not been able to do this. !n intercultural encounter consists
of an inside or native perspective 4emic worldview5 and an outsider:s perspective 4ethic
worldview5. .he nurse is obviousl utili?ing an ethic worldview. .he nurse ma be acultural,
but she@he did not purposefull ignore the patient:s need.
D'(# !ppl R)(# 1*3-1*7
+,-# Describe steps toward developing cultural competence. .+/# 'mplementation
0S$# "ursing /rocess
A. 'n performing a cultural assessment, %nowledge of a patient:s countr of origin and its histor
and ecological conte&ts is %nown as
a
.
)thnohistor.
b
.
,iocultural histor.
c
.
Social organi?ation.
d
.
Religious and spiritual beliefs.
!"S# !
Bnowledge of a patient:s countr of origin and its histor and ecological conte&ts is
significant to health care and is %nown as ethnic heritage and ethnohistor. ,iocultural histor
identifies a patient:s health ris%s related to the ecological conte&t of the culture. Social
organi?ation refers to units of organi?ation in a cultural group defined b %inship status and
appropriate roles for their members. Religious and spiritual beliefs are ma6or influences in the
patient:s worldview about health and illness, pain and suffering, and life and death. "urses
need to understand the emic perspective of their patients.
D'(# Remember R)(# 1*AC 11* +,-# 'dentif ma6or components of cultural assessment.
.+/# !ssessment 0S$# "ursing /rocess
D. .he nurse is caring for a patient of !sian descent who spea%s ver little )nglish. .he nurse is
especiall concerned and attempts to develop a trusting relationship with the patient. She does
this %nowing that
a
.
$ultural assessment needs to be done quic%l to provide the best care earl.
b
.
0iscommunication cannot be tolerated in cultural assessment.
c
.
.he goal is to get the patient to conform to !merican health care norms.
d
.
$ultural assessment is intrusive in contrast to other tpes of interviews.
!"S# D
'n contrast to other tpes of interviews, cultural assessment is intrusive and time-consuming
and requires a trusting relationship between participants. 0iscommunication commonl
occurs in intercultural interactions as the result of language and communication differences
between and among participants, as well as differences in interpreting each other:s behaviors.
.he goal is to generate %nowledge about the patient:s values, beliefs, and practices about
nursing and health care.
D'(# !ppl R)(# 1*A +,-# 'dentif ma6or components of cultural assessment.
.+/# 'mplementation 0S$# "ursing /rocess
E. .he nurse is caring for a patient who has emigrated from another countr. .he patient is in
need of abdominal surger but seems reluctant to sign the surgical permits. 8hat is one tactic
that the nurse should use9
a
.
Determine the famil social hierarch.
b
.
)ncourage the patient to sign the permits.
c
.
$all the phsician so that surger can be canceled.
d
.
'mpress on the patient that her life is in 6eopard.
!"S# !
"urses should determine the famil social hierarch as soon as possible to prevent offending
patients and their families. 8or%ing with established famil hierarch prevents delas and
achieves better patient outcomes. )ncouraging the patient to sign against her social beliefs can
cause familial strife. )&plaining the level of 6eopard ma create undue stress. "urses should
be able to determine the correct hierarch and should not involve the phsician at this time.
D'(# !ppl R)(# 1*AC 111 +,-# 'dentif ma6or components of cultural assessment.
.+/# 'mplementation 0S$# "ursing /rocess
1*. .he nurse is caring for a $hinese patient who is reluctant to answer questions about her health
bac%ground. .he nurse as%s the patient if she would li%e her husband present when health
questions are as%ed. .he nurse does this %nowing that the $hinese culture is a collectivistic
and patrilineal culture. 8hat does this mean9
a
.
Binship e&tends to both the father:s side and the mother:s side of the famil.
b
.
Binship is limited to the side of the father.
c
.
Binship is limited to the side of the mother.
d
.
.he husband becomes part of the wife:s clan after marriage.
!"S# ,
'n collectivistic cultures, families are made up of distant blood relatives across three
generations and fictive or nonblood %in. Binship e&tends to both the father:s and the mother:s
side of the famil 4bilineal5 or is limited to the side of either father 4patrilineal5 or mother
4matrilineal5. /atrilineall e&tended families e&ist among $hinese and Hindus, where a
woman moves into her husband:s clan after marriage and minimi?es ties with her own parents
and siblings.
D'(# Understand R)(# 111
+,-# Use cultural assessment to identif significant values, beliefs, and practices critical to nursing
care of individuals e&periencing life transitions. .+/# !ssessment
0S$# "ursing /rocess
11. .he nurse is caring for a patient who does not spea% )nglish. She decides to use an interpreter
to e&plain procedures and to answer questions that the patient ma have. 'n performing the
interview, what should the nurse do9
a
.
Direct questions to the interpreter to as% the patient.
b
.
Disregard the age and gender of the interpreter.
c
.
Direct questions to the patient.
d
.
!s% the interpreter to as% the patient for clarification at the end.
!"S# $
'f the patient needs an interpreter, the nurse should ensure gender, age, and ethnic
compatibilit of the interpreter with the patient:s preference and the topic of discussion. .he
nurse should direct questions to the patient and not to the interpreter and should have the
interpreter as% the patient for feedbac% and clarification at regular intervals, not onl at the
end.
D'(# !ppl R)(# 1*=-1*>
+,-# Use cultural assessment to identif significant values, beliefs, and practices critical to nursing
care of individuals e&periencing life transitions. .+/# 'mplementation
0S$# "ursing /rocess
11. 8hich statement is true relative to caring for a Hindu patient who is ding9
a
.
.he famil will turn his head eastward or to the right.
b
.
! close %in will sta with the patient to hear his last wishes.
c
.
!nointing of the sic% is a common right of the ding.
d
.
.he famil will place a drop of water on the patient:s lips.
!"S# D
.he famil of a ding Hindu remains at the bedside to place a drop of the hol water from the
River Fanges on the patient:s lips immediatel after death to help his or her soul to the ne&t
life. .he famil of a criticall ill -ewish patient will turn his or her head eastward or to the
right side. ! ding Hispanic patient will not be left alone, so that a close %in is able to hear the
patient:s wishes, allowing the soul to leave in peace. !nointing of the sic% is a Roman
$atholic sacrament.
D'(# !ppl R)(# 111
+,-# Use cultural assessment to identif significant values, beliefs, and practices critical to nursing
care of individuals e&periencing life transitions. .+/# 'mplementation
0S$# "ursing /rocess
13. 'n comparing !merican culture with !sian cultures, which of the following statements is true9
a !merican culture supports collectivism.
.
b
.
!sian communication can be ambiguous.
c
.
!merican communication patterns downpla autonom.
d
.
!sian communication is direct to avoid conflict.
!"S# ,
!mong !sian cultures, face-saving communication promotes harmon through indirect,
ambiguous communication and conflict avoidance. !merican culture supports individualism,
where people value assertive communication because it manifests the ideals of individual
autonom and self-determination.
D'(# !nal?e R)(# 111
+,-# Use cultural assessment to identif significant values, beliefs, and practices critical to nursing
care of individuals e&periencing life transitions. .+/# )valuation
0S$# "ursing /rocess
17. 8hen caring for a patient of a different culture, it is important for the nurse to understand that
a
.
.he nurse should protect the patient from famil intrusion in her health care
decisions.
b
.
8or%ing within the established famil hierarch produces better outcomes.
c
.
8omen as primar caregivers ma%e independent health decisions.
d
.
Fender is not a factor when it comes to role e&pectations.
!"S# ,
8or%ing with established famil hierarch prevents delas and achieves better patient
outcomes. "urses need to determine who has authorit for ma%ing decisions within the famil
and how to communicate with the proper individuals. Do not assume that 6ust because the
woman is the primar caregiver, she will ma%e decisions independentl. Determine the famil
social hierarch as soon as possible. Fender also differentiates role e&pectations.
D'(# Understand R)(# 111
+,-# Demonstrate nursing interventions that achieve culturall congruent care.
.+/# )valuation 0S$# "ursing /rocess
1=. .he nurse is caring for a member of the -ewish faith who needs to undergo a critical
procedure on Saturda. .he patient is refusing the procedure because it is scheduled to be
done on the Sabbath. .he nurse impresses on the patient the urgenc of the procedure, stating
that delaing the procedure would put his life at ris%. .he patient continues to refuse. 8hat
should the nurse do9
a
.
$ancel the procedure.
b
.
See% permission from the patient to contact the patient:s rabbi.
c
.
Have a famil member sign the permit.
d
.
Have the procedure done against patient wishes.
!"S# ,
"urses need to identif and contact patients: religious and spiritual leaders before problems
occur. "urses wor% with these leaders to mediate in times of crises. $anceling the procedure
ma occur, but not at this time. Doing so prematurel could lead to the patient:s death. !
famil member cannot ma%e decisions for a competent patient. Having the procedure done
against the patient:s wishes cannot be done.
D'(# !ppl R)(# 111
+,-# Demonstrate nursing interventions that achieve culturall congruent care.
.+/# 'mplementation 0S$# "ursing /rocess
1>. .he nurse is providing diabetic diet teaching to a Hispanic man and his wife. 8hen the nurse
is discussing foods that are acceptable, the wife continues to interrupt with statements li%e,
;+h, he doesn:t eat that,< or, ;!ll he eats is rice and beans.< 8hat should the nurse do9
a
.
!s% the wife to leave so he@she can focus on teaching the patient.
b
.
)&plain how ;rice and beans< are not acceptable foods on a diabetic diet.
c
.
/rovide a diet plan with onl food alternatives selected b the patient.
d
.
Refer the patient and his wife to a dietitian familiar with Spanish food choices.
!"S# D
.he nurse should refer the patient to spea% with a dietitian who is familiar with cultural food
choices. 'f possible, he@she should develop a diet plan that includes the patient:s cultural diet
preferences and can provide culturall sensitive teaching brochures that describe health food
choices. Rice and beans ma be acceptable alternatives in a balanced diet. .he nurse should
include people in the famil who help shop for and prepare food in the home, along with the
wife.
D'(# !ppl R)(# 111
+,-# Demonstrate nursing interventions that achieve culturall congruent care.
.+/# 'mplementation 0S$# "ursing /rocess
1A. /roviding culturall congruent care means providing care that
a
.
(its the patient:s valued life patterns and set of meanings.
b
.
's based on meanings generated b predetermined criteria.
c
.
's the same as the values of the professional health care sstem.
d
.
Holds one:s own wa of life as superior to those of others.
!"S# !
.he goal of transcultural nursing is culturall congruent care, or care that fits the person:s
valued life patterns and set of meanings. /atterns and meanings are generated from people
themselves, rather than from predetermined criteria. $ulturall congruent care is sometimes
different from the values and meanings of the professional health care sstem. )thnocentrism
is a tendenc to hold one:s own wa of life as superior to those of others. 't is not part of
culturall congruent care.
D'(# Understand R)(# 113 +,-# !nal?e outcomes of culturall congruent care.
.+/# !ssessment 0S$# "ursing /rocess
1D. 2eininger 41EE15 identified three nursing decision and action modes to achieve culturall
congruent care. .hese modes are ;cultural care preservation or maintenance,< ;cultural care
accommodation,< and ;cultural care repatterning.< 8hen assessing patients during the
admission process, the nurse utili?es
a
.
.hese action modes in a distinct order.
b
.
.hese action modes individuall, one at a time.
c
.
+nl one action mode per patient.
d
.
!ll these action modes simultaneousl.
!"S# D
"urses are able to use an or all of these action modes simultaneousl. .hese actions require
that nurses have %nowledge of the patient:s culture and have the willingness, commitment,
and s%ills to wor% with patients and families in decision ma%ing. .he outcome sought through
these actions and decisions is meaningful, supportive, and facilitative care as 6udged b the
patient.
D'(# !ppl R)(# 113
+,-# !ppl research findings in culturall congruent care. .+/# 'mplementation
0S$# "ursing /rocess
MULTIPLE RESPOSE
1. $ompare the following statements. 8hich are considered predominant in non-8estern
cultures9 (Select all that apply.)
a
.
$auses of illness are biomedical in nature.
b
.
'llness is an imbalance between humans and nature.
c
.
$aring patterns are based in self-care and self-determination.
d
.
Diagnoses are described as holistic.
e .reatment of disease can be magico-religious based.
.
!"S# ,, D, )
0an non-8estern cultures see the cause of illness as being an imbalance between humans
and nature. 0ethod of diagnosis is described as holistic, and treatment of illness is mi&ed to
include magico-religious, supernatural herbal, biomedical, etc. 8estern cultures view the
cause of illness as biomedical using scientific, high-tech methods of diagnosis.
D'(# !nal?e R)(# 1*7 +,-# !nal?e outcomes of culturall congruent care.
.+/# )valuation 0S$# "ursing /rocess
1. (oster 41EA>5 identified two distinct categories of healers cross-culturall. +f the following
characteristics, which are congruent with the healing practices of naturalistic practitioners9
(Select all that apply.)
a
.
'llness is impersonal and is due to biological forces.
b
.
'llness is caused b alterations in the bod equilibrium.
c
.
Sorcerers can cause health and illness.
d
.
Human relationships should be emphasi?ed.
e
.
Healing modalities include herbs, massage, and surger.
!"S# !, ,, )
"aturalistic practitioners attribute illness to natural, impersonal, and biological forces that
cause alteration in the equilibrium of the human bod. Healing emphasi?es use of naturalistic
modalities, including herbs, chemicals, heat, cold, massage, and surger. 'n contrast,
personalistic practitioners believe that an e&ternal agent, which can be human 4i.e., sorcerer5
or nonhuman 4e.g., ghosts, evil, deit5, causes health and illness. /ersonalistic beliefs
emphasi?e the importance of humans: relationships with others, both living and deceased, and
with their deities.
D'(# )valuate R)(# 1*7
+,-# !ppl research findings in culturall congruent care. .+/# )valuation
0S$# "ursing /rocess