Chapter 09: Cultural Awareness
Chapter 09: Cultural Awareness
Potter et al.: Fundamentals of Nursing, 9th Edition
MULTIPLE CHOICE
1. A nurse is working at a health fair screening people for liver cancer. Which population group
should the nurse monitor most closely for liver cancer?
a.
Hispanic
b.
Asian Americans
c.
Non-Hispanic Caucasians
d.
Non-Hispanic African-Americans
ANS: B
While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian
population, they also have the highest incidence rates of liver cancer for both sexes compared with
Hispanic, non-Hispanic Caucasians, or non-Hispanic African-Americans.
DIF: Apply (application) REF: 101
OBJ: Describe cultural influences on health and illness. TOP: Assessment
MSC: Health Promotion and Maintenance
2. A nurse is caring for an immigrant with low income. Which information should the nurse consider
when planning care for this patient?
a.
There is a decreased frequency of morbidity.
b.
There is an increased incidence of disease.
c.
There is an increased level of health.
d.
There is a decreased mortality rate.
ANS: B
Populations with health disparities (immigrant with low income) have a significantly increased
incidence of disease or increased morbidity and mortality when compared with the general
population. Although Americans’ health overall has improved during the past few decades, the health
of members of marginalized groups has actually declined.
DIF: Understand (comprehension) REF: 101-102
OBJ: Describe cultural influences on health and illness. TOP: Planning
MSC: Management of Care
3. A nurse is assessing the health care disparities among population groups. Which area is the nurse
monitoring?
a.
Accessibility of health care services
b.
Outcomes of health conditions
c.
Prevalence of complications
d.
Incidence of diseases
ANS: A
While health disparities are the differences among populations in the incidence, prevalence, and
outcomes of health conditions, diseases and related complications, health care disparities are
differences among populations in the availability, accessibility, and quality of health care services
(e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention,
treatment, and management of diseases and their complications.
DIF: Apply (application) REF: 102
OBJ: Describe health disparities and social determinants of health. TOP:
Assessment MSC: Health Promotion and Maintenance
4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates
cultural competence?
a.
Communicates effectively in a multicultural context
b.
Functions effectively in a multicultural context
c.
Visits a foreign country
d.
Speaks a different language
ANS: B
Cultural competence refers to a developmental process that evolves over time that impacts ability to
effectively function in the multicultural context. Communicates effectively and speaking a different
language indicates linguistic competence. Visiting a foreign country does not indicate cultural
competence.
DIF: Apply (application) REF: 103
OBJ: Describe steps toward developing cultural competence. TOP: Implementation
MSC: Psychosocial Integrity
5. The nurse learns about cultural issues involved in the patient’s health care belief system and
enables patients and families to achieve meaningful and supportive care. Which concept is the nurse
demonstrating?
a.
Marginalized groups
b.
Health care disparity
c.
Transcultural nursing
d.
Culturally congruent care
ANS: D
The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a
person’s life patterns, values, and system of meaning, provides meaningful and beneficial nursing
care. Marginalized groups are populations left out or excluded. Health care disparities are differences
among populations in the availability, accessibility, and quality of health care services (e.g.
screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and
management of diseases and their complications. Transcultural nursing is a comparative study of
cultures in order to understand their similarities (culture that is universal) and the differences among
them (culture that is specific to particular groups).
DIF: Apply (application) REF: 103
OBJ: Explain how the many facets of culture affect a health care provider’s ability to provide
culturally congruent care. TOP: Implementation
MSC: Psychosocial Integrity
6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care.
Which step should the nurse take first?
a.
Assessing own biases and attitude
b.
Learning about the world view of others
c.
Understanding organizational forces
d.
Developing cultural skills
ANS: A
Becoming more aware of your biases and attitudes about human behavior is the first step in
providing patient-centered care, leading to culturally competent care. It is helpful to think about
cultural competence as a lifelong process of learning about others and also about yourself. Learning
about the world view, developing cultural skills, and understanding organizational forces are not the
first steps.
DIF: Apply (application) REF: 105
OBJ: Describe the relationship between cultural competence and patient-centered care.
TOP: Implementation MSC: Psychosocial Integrity
7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication.
Which area will the nurse assess for the “H”?
a.
Health
b.
Healers
c.
History
d.
Homeland
ANS: B
The “H” in ETHNIC stands for healers: Has the patient sought advice from alternative health
practitioners? While health, history, and homeland are important, they are not components of “H.”
DIF: Apply (application) REF: 109
OBJ: Use cultural assessment to plan culturally competent
care. TOP: Assessment MSC: Psychosocial Integrity
8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working
with an interpreter. Which action should the nurse take?
a.
Use long sentences when talking.
b.
Look at the patient when talking.
c.
Use breaks in sentences when talking.
d.
Look at only nonverbal behaviors when talking.
ANS: B
Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace
your speech by using short sentences, but do not break your sentences. Observe the patient’s
nonverbal and verbal behaviors.
DIF: Apply (application) REF: 110
OBJ: Discuss research findings applicable to culturally competent
care. TOP: Implementation MSC: Psychosocial Integrity
9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients?
a.
Provides care to transgender patients
b.
Provides care to restore relationships
c.
Provides care to patients that is individualized
d.
Provides care to surgical patients
ANS: A
Although cultural competence and patient-centered care both aim to improve health care quality,
their focus is slightly different. The primary aim of cultural competence care is to reduce health
disparities and increase health equity and fairness by concentrating on people of color and other
marginalized groups, like transgender patients. Patient-centered care, rather than cultural competence
care, provides individualized care and restores an emphasis on personal relationships; it aims to
elevate quality for all patients.
DIF: Apply (application) REF: 105
OBJ: Describe the relationship between cultural competence and patient-centered care.
TOP: Implementation MSC: Psychosocial Integrity
10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the
nurse indicates successful implementation of this technique?
a.
Asks, “Does this make sense?”
b.
Asks, “Do you think you can do this at home?”
c.
Asks, “What will you tell your spouse about changing the dressing?”
d.
Asks, “Would you tell me if you don’t understand something so we can go over it?”
ANS: C
The Teach-Back technique asks open-ended questions, like what will you tell your spouse about
changing the dressing, to verify a patient’s understanding. When using the Teach-Back technique do
not ask a patient, “Do you understand?” or “Do you have any questions?” Does this make sense and
do you think you can do this at home are closed-ended questions. Would you tell me if you don’t
understand something so we can go over it is not verifying a patient’s understanding about the
teaching.
DIF: Apply (application) REF: 110-111
OBJ: Discuss research findings applicable to culturally competent care.
TOP: Teaching/Learning MSC: Health Promotion and Maintenance
11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus
on to cause the most improvement in core measures?
a.
Caucasians
b.
Poor people
c.
Alaska Natives
d.
American Indians
ANS: B
To improve results, the nurse should focus on the highest disparity. Poor people received worse care
than high-income people for about 60% of core measures. American Indians and Alaska Natives
received worse care than Caucasians for about 30% of core measures.
DIF: Analyze (analysis) REF: 111
OBJ: Discuss research findings applicable to culturally competent care. TOP: Evaluation MSC:
Management of Care
12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which
design should the nurse use?
a.
Use partnered rather than married.
b.
Use mother rather than father.
c.
Use parents rather than guardian.
d.
Use wife/husband rather than significant other.
ANS: A
Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that
disclosure is a choice impacted by many factors. For example, provide options such as “partnered”
under relationship status. For parents, use parent/guardian, instead of mother/father. Use neutral and
inclusive language when talking with patients (e.g., partner or significant other), listening and
reflecting patient’s choice. Remember that some LGBT patients are also legally married.
DIF: Understand (comprehension) REF: 105
OBJ: Discuss research findings applicable to equity-focused quality improvement.
TOP: Caring MSC: Management of Care
13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which
group should the nurse monitor most closely?
a.
Young bisexuals
b.
Young caucasians
c.
Asian Americans
d.
African-Americans
ANS: A
Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety,
suicide attempts, and substance use disorders, being 4 times as likely as their straight peers to make
suicide attempts that require medical attention. Caucasian youth, Asian Americans, and AfricanAmericans are not as likely to attempt suicide resulting in medical attention.
DIF: Understand (comprehension) REF: 101
OBJ: Explain how the many facets of culture affect a health care provider’s ability to
provide culturally congruent care. TOP: Assessment
MSC: Health Promotion and Maintenance
14. A nurse is assessing a patient’s ethno history. Which question should the nurse ask?
a.
What language do you speak at home?
b.
How different is your life here from back home?
c.
Which caregivers do you seek when you are sick?
d.
How different is what we do from what your family does when you are sick?
ANS: B
An ethnohistory question is the following: How different is your life here from back home? Caring
beliefs and practice questions include the following: Which caregivers do you seek when you are sick
and How different is what we do from what your family does when you are sick? The language and
communication is the following: What language do you speak at home?
DIF: Understand (comprehension) REF: 107
OBJ: Use cultural assessment to plan culturally competent care. TOP: Assessment MSC: Health
Promotion and Maintenance
15. A nurse is teaching patients about health care information. Which patient will the nurse assess
closely for health literacy?
a.
A patient 35 years old
b.
A patient 68 years old
c.
A patient with a college degree
d.
A patient with a high-school diploma
ANS: B
About 9 out of 10 people in the United States experience challenges in using health care information.
Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low
incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental
and/or physical health conditions. A 35-year-old patient and patients with high-school and college
education are not identified in the vulnerable populations.
DIF: Apply (application) REF: 110
OBJ: Discuss research findings applicable to culturally competent care.
TOP: Assessment MSC: Health Promotion and Maintenance
16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the
hospital using?
a.
Document staff satisfaction.
b.
Focus on the family.
c.
Implement change on a grand scale.
d.
Reduce disparities.
ANS: D
Organizations can implement equity-focused quality improvement by recognizing disparities and
committing to reducing them. Staff diversity is a priority for equity-focused quality improvement, not
staff satisfaction. While the family is important, the focus is on the patients. Organizations should
start by implementing a change on a small scale (pilot testing), learning from each test, and refining
the intervention through performance improvement cycles (e.g., plan, do, study, and act).
DIF: Understand (comprehension)REF:112
OBJ: Discuss research finding applicable to equity-focused quality improvement.
TOP: Planning MSC: Management of Care
17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is
successful in the role of providing culturally congruent care?
a.
Provides care that fits the patient’s valued life patterns and set of meanings
b.
Provides care that is based on meanings generated by predetermined criteria
c.
Provides care that makes the nurse the leader in determining what is needed
d.
Provides care that is the same as the values of the professional health care system
ANS: A
The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person’s
life patterns, values, and system of meaning. Patterns and meanings are generated from people
themselves, rather than from predetermined criteria. Discovering patients’ cultural values, beliefs,
and practices as they relate to nursing and health care requires you to assume the role of learner (not
become the leader) and to partner with your patients and their families to determine what is needed to
provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different
from the values and meanings of the professional health care system.
DIF: Apply (application )REF: 103
OBJ: Explain how the many facets of culture affect a health care provider’s ability to provide
culturally congruent care. TOP: Implementation
MSC: Psychosocial Integrity
18. A nurse is assessing the patient’s meaning of illness. Which area of focus by the nurse
is priority?
a.
On the way a patient reacts to disease
b.
On the malfunctioning of biological processes
c.
On the malfunctioning of psychological processes
d.
On the way a patient reacts to family/social interactions
ANS: A
To provide culturally congruent care, you need to understand the difference between disease and
illness. Illness is the way that individuals and families react to disease, whereas disease is a
malfunctioning of biological or psychological processes. The way a patient interacts to family/social
interactions is communication processes and family dynamics.
DIF: Understand (comprehension) REF: 103
OBJ: Explain how the many facets of culture affect a health care provider’s ability to provide culturally
congruent care. TOP: Implementation
MSC: Management of Care
MULTIPLE RESPONSE
1. A nurse is using Campinha-Bacote’s model of cultural competency. Which areas will the nurse
focus on to become competent? (Select all that apply.)
a.
Cultural skills
b.
Cultural desire
c.
Cultural transition
d.
Cultural knowledge
e.
Cultural encounters
ANS: A, B, D, E
Campinha-Bacote’s model of cultural competency has five interrelated components: cultural
awareness; cultural knowledge; cultural skills; cultural encounters; and cultural desire. Cultural
transition is not a component of this model.
DIF: Understand (comprehension) REF: 104-105
OBJ: Discuss research findings applicable to culturally competent care. TOP: Caring MSC: Psychosocial
Integrity
2. A nurse is using the RESPECT mnemonic to establish rapport, the “R” in RESPECT. Which
actions should the nurse take? (Select all that apply.)
a.
Connect on a social level.
b.
Help the patient overcome barriers.
c.
Consciously attempt to suspend judgment.
d.
Stress that they will be working together to address problems.
e.
Know limitations in addressing medical issues across cultures.
ANS: A, C
The “R” in RESPECT stands for rapport and includes the following behaviors: connect on a social
level; seek the patient’s point of view; and consciously attempt to suspend judgment. The “S” stands
for support and includes the behavior of helping the patient overcome barriers. The “P” stands for
partnership and includes the following behaviors: be flexible with regard to issues of control and
stress that you will be working together to address medical problems. The “C” stands for cultural
competence and includes the behavior of knowing your limitations in addressing medical issues
across cultures.
DIF: Apply (application) REF: 109
OBJ: Discuss research findings applicable to culturally congruent care. TOP: Caring MSC: Psychosocial
Integrity
3. A nurse is using the explanatory model to determine the etiology of an illness. Which questions
should the nurse ask? (Select all that apply.)
a.
How should your sickness be treated?
b.
What do you call your problem?
c.
How does this illness work inside your body?
d.
What do you fear most about your sickness?
e.
What name does it have?
ANS: B, C, E
The questions for etiology include “What do you call your problem?” and “What name does it
have?” Recommended treatment is asked by the question “How should your sickness be treated?”
Pathophysiology is asked by the question “How does this illness work inside your body?” The course
of illness is asked by the question “What do you fear most about your sickness?”
DIF: Understand (comprehension) REF: 108
OBJ: Use cultural assessment to plan culturally competent
care. TOP: Assessment MSC: Management of Care
MATCHING
A nurse is using Campinha-Bacote’s model of cultural competency to improve cultural care. Which
actions describe the components the nurse is using?
a.
In-depth self-examination of one’s own background
b.
Ability to assess factors that influence treatment and care
c.
Sufficient comparative understanding of diverse groups
d.
Motivation and commitment to continue learning about cultures
e.
Cross-cultural interaction that develops communication skills
1. Cultural skills
2. Cultural desires
3. Cultural awareness
4. Cultural knowledge
5. Cultural encounters
1. ANS: B DIF: Understand (comprehension) REF: 104-105
OBJ: Describe steps toward developing cultural
competence. TOP: Assessment MSC: Management of
Care
2. ANS: DIF: Understand (comprehension) REF: 104-105
OBJ: Describe steps toward developing cultural
competence. TOP: Assessment MSC: Management of
Care
3. ANS:A DIF: Understand (comprehension)REF:104-105
OBJ: Describe steps toward developing cultural
competence. TOP: Assessment MSC: Management of
Care
4. ANS: C DIF: Understand (comprehension) REF: 104-105
OBJ: Describe steps toward developing cultural
competence. TOP: Assessment MSC: Management of
Care
5. ANS: E DIF: Understand (comprehension) REF: 104-105
OBJ: Describe steps toward developing cultural competence. TOP: Assessment
MSC: Management of Care