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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 in uences on health and illness. TOP: Assessment
MSC:Health Promotion and Maintenance
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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 signi cantly 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 in uences 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
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While health disparities are the di erences among populations in the incidence, prevalence, and outcomes of
health conditions, diseases and related complications, health care disparities are di erences 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
escribe health disparities and social determinants of health.
TOP:AssessmentMSC:Health Promotion and Maintenance
4. A nurse is providing care to a patient from a di erent culture. Which action by the nurse indicates cultural
competence?
a.
Communicates e ectively in a multicultural context
b.
Functions e ectively in a multicultural context
c.
Visits a foreign country
d.
Speaks a di erent language
ANS: B
Cultural competence refers to a developmental process that evolves over time that impacts ability to e ectively
function in the multicultural context. Communicates e ectively and speaking a di erent 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
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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 ts a person’s life
patterns, values, and system of meaning, provides meaningful and bene cial nursing care. Marginalized groups
are populations left out or excluded. Health care disparities are di erences 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 di erences among them (culture that is speci c to particular groups).
DIF:Apply (application)REF:103
OBJ:Explain how the many facets of culture a ect 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 †rst?
a.
Assessing own biases and attitude
b.
Learning about the world view of others
c.
Understanding organizational forces
d.
Developing cultural skills
ANS: A
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Becoming more aware of your biases and attitudes about human behavior is the rst step in providing patientcentered 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 rst 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.
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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
iscuss research ndings 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 di erent. 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
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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
iscuss research ndings 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
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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
iscuss research ndings applicable to culturally competent care.
TOP:EvaluationMSC: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 signi cant 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 signi cant other), listening and re ecting patient’s choice. Remember that some
LGBT patients are also legally married.
DIF:Understand (comprehension)REF:105
OBJ: Discuss research ndings applicable to equity-focused quality improvement.
TOP:CaringMSC:Management of Care
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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 signi cantly 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 African-Americans are not as likely to
attempt suicide resulting in medical attention.
DIF:Understand (comprehension)REF:101
OBJ:Explain how the many facets of culture a ect 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 ethnohistory. Which question should the nurse ask?
a.
What language do you speak at home?
b.
How di erent is your life here from back home?
c.
Which caregivers do you seek when you are sick?
d.
How di erent is what we do from what your family does when you are sick?
ANS: B
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An ethnohistory question is the following: How di erent 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 di erent 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:AssessmentMSC: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 identi ed in the vulnerable
populations.
DIF:Apply (application)REF:110
OBJ
iscuss research ndings applicable to culturally competent care.
TOP:AssessmentMSC:Health Promotion and Maintenance
16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital
using?
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a.
Document sta 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. Sta diversity is a priority for equity-focused quality improvement, not sta 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 re ning the intervention through performance
improvement cycles (e.g., plan, do, study, and act).
DIF:Understand (comprehension)REF:112
OBJ: Discuss research nding applicable to equity-focused quality improvement.
TOP
lanningMSC: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 ts 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 ts the person’s life
patterns, values, and system of meaning. Patterns and meanings are generated from people themselves,
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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 bene cial
nursing care. Culturally congruent care is sometimes di erent from the values and meanings of the
professional health care system.
DIF:Apply (application)REF:103
OBJ:Explain how the many facets of culture a ect 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 di erence 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 a ect a health care provider’s ability to provide culturally congruent
care.TOP:Implementation
MSC:Management of Care
MULTIPLE RESPONSE
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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 ve 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
iscuss research ndings 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.
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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 exible 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
iscuss research ndings 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
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OBJ:Use cultural assessment to plan culturally competent care.
TOP:AssessmentMSC: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 in uence treatment and care
c.
Su cient 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:BDIF: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
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MSC:Management of Care
3.ANS:ADIF:Understand (comprehension)REF:104-105
OBJ: Describe steps toward developing cultural competence. TOP: Assessment
MSC:Management of Care
4.ANS:CDIF:Understand (comprehension)REF:104-105
OBJ: Describe steps toward developing cultural competence. TOP: Assessment
MSC:Management of Care
5.ANS:EDIF:Understand (comprehension)REF:104-105
OBJ: Describe steps toward developing cultural competence. TOP: Assessment
MSC:Management of Care
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