Chapter 05: Cultural Implications
Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach,
8th Edition
MULTIPLE CHOICE
1. Which Western cultural feature may result in establishing
unrealistic outcomes for patients of other cultural groups?
a. Interdependence
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems
ANS: D
Directly confronting problems is a highly valued approach in
the American culture but not part of many other cultures in
which harmony and restraint are valued. American nurses
sometimes mistakenly think that all patients should take
direct action. Patients with other values will be unable to
meet this culturally inappropriate outcome. Present
orientation, interdependence, and a flexible perception of
time are not valued in Western culture. These views are more
predominant in other cultures. See relationship to audience response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 5-33 (Table 5-4)
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
2. A psychiatric nurse leads a medication education group for Hispanic patients. This nurse
holds a Western worldview and uses pamphlets as teaching tools. Groups are short and
concise. After the group, the patients are most likely to believe
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 value relationship behaviors. Their needs are for learning
through verbal communication rather than reading and for having time to chat before
approaching the task.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-29 (Table 5-2)
TOP: Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
3. To provide culturally competent care, the nurse should
a. accurately interpret the thinking of individual patients.
b. predict how a patient may perceive treatment interventions.
c. formulate interventions to reduce the patient’s ethnocentrism.
d. identify strategies that fit within the cultural context of the patient.
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ANS: D
The correct answer is the most global response. Cultural competence requires ongoing
effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain
cultural knowledge and determine nursing care measures that patients find acceptable and
helpful. Interpreting the thinking of individual patients does not ensure culturally competent
care. Reducing a patient’s ethnocentrism may not be a desired outcome.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-11
TOP: Nursing Process: Planning/Outcomes Identification
MSC: Client Needs: Psychosocial Integrity
4. A black patient, originally from Haiti, has a diagnosis of major depressive disorder. A
colleague tells the nurse, “This patient often looks down and is reluctant to share feelings.
However, I’ve observed the patient spontaneously interacting with other black patients.”
Select the nurse’s best response.
a. “Black patients depend on the church for support. Have you consulted the patient’s
pastor?”
b. “Encourage the patient to talk in a group setting. It will be less intimidating than
one-to-one interaction.”
c. “Don’t take it personally. Black patients often have a resentful attitude that takes a
long time to overcome.”
d. “The patient may have difficulty communicating in English. Have you considered
using a cultural broker?”
ANS: D
Society expects a culturally diverse patient to accommodate and use English. Feelings are
abstract, which requires a greater command of the language. This may be especially difficult
during episodes of high stress or mental illness. Cultural brokers can be helpful with
language and helping the nurse to understand the Haitian worldview and cultural nuances.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-8
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. A Haitian patient diagnosed with major depressive disorder tells the nurse, “There’s nothing
you can do. This is a punishment. The only thing I can do is see a healer.” The culturally
aware nurse assesses that the patient
a. has delusions of persecution.
b. has likely been misdiagnosed with depression.
c. may believe the distress is the result of a curse or spell.
d. feels hopeless and helpless related to an unidentified cause.
ANS: C
Individuals of African American or Caribbean cultures who have a fatalistic attitude about
illness may believe they are being punished for wrongdoing or are victims of witchcraft or
voodoo. They may be reticent to share information about curses with therapists. No data are
present in the scenario to support delusions. Misdiagnosis more often labels a patient with
depression as having schizophrenia.
PTS: 1
DIF:
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Cognitive Level: Apply (Application)
REF: Page 5-29 (Table 5-2) | Page 5-33 (Table 5-4)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
6. A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient,
who was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best
explains this behavior?
a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behavior indicates feelings of self-importance that the patient wants others to
appreciate.
ANS: C
Culture is more than ethnicity and social norms; it includes religious, geographic,
socioeconomic, occupational, ability- or disability-related, and sexual orientation-related
beliefs and behaviors. In this instance, the patient’s military experience represents an aspect
of the patient’s behavior. The military culture values timeliness. The distracters represent
misinterpretation of the patient’s behavior and have no bearing on the situation.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 5-6, 33 (Table 5-4), 37 (Box 5-1)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
7. A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives
at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at
all. What understanding will improve the nurse’s planning? These patients are
a. members of cultural groups that have a different view of time.
b. immature and irresponsible in health care matters.
c. acting-out feelings of anger toward the system.
d. displaying passive-aggressive tendencies.
ANS: A
Hispanic Americans and Native Americans traditionally treat time in a way unlike the
Western culture. They tend to be present-oriented; that is, they value the current interaction
more than what is to be done in the future. If engaged in an activity, for example, they may
simply continue the activity and appear later for an appointment. Understanding this, the
nurse can avoid feelings of frustration and anger when the nurse’s future orientation comes
into conflict with the patient’s present orientation.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 5-6, 29 (Table 5-2)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
8. The sibling of an Asian American patient tells the nurse, “My sister needs help for pain. She
cries from the hurt.” Which understanding by the nurse will contribute to culturally
competent care for this patient? Persons of an Asian American heritage
a. often express emotional distress with physical symptoms.
b. will probably respond best to a therapist who is impersonal.
c. will require prolonged treatment to stabilize these symptoms.
d. should be given direct information about the diagnosis and prognosis.
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ANS: A
Asian Americans commonly express psychological distress as a physical problem. The
patient may believe psychological problems are caused by a physical imbalance. Treatment
will likely be short. The patient will probably respond best to a therapist who is perceived as
giving. Asian Americans usually have strong family ties and value hope more than truth.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 5-10, 35 (Table 5-5)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. Which communication strategy would be most effective for a nurse to use during an
assessment interview with an adult Native American patient?
a. Open and friendly; ask direct questions; touch the patient’s arm or hand
occasionally for reassurance.
b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional
face to express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
ANS: C
Native American culture stresses living in harmony with nature. Cooperative, sharing styles
rather than competitive or intrusive approaches are preferred; thus, the more passive style
described would be best received. The other options would be more effective to use with
patients of a Western orientation.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 5-17, 29 (Table 5-2) | Page 5-31 (Table 5-3) | Page 5-37 (Box 5-1)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
10. A Native American patient sadly describes a difficult childhood. The patient abused alcohol
as a teenager but stopped 10 years ago. The patient now says, “I feel stupid and good for
nothing. I don’t help my people.” How should the treatment team focus planning for this
patient?
a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytical approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.
ANS: D
Native Americans, because of their beliefs in the interrelatedness of parts and about being in
harmony with nature, respond best to a holistic approach. No data are present to support
dual diagnosis, because the patient has resolved the problem of excessive alcohol use.
Psychopharmacological and somatic therapies may be part of the treatment, but the focus
should be more holistic. Psychoanalysis is a long-term expensive therapy; cognitive therapy
might be a better choice.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-6 | Page 5-29 (Table 5-2) | Page 5-33 (Table 5-4)
TOP: Nursing Process: Planning/Outcomes Identification
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MSC: Client Needs: Psychosocial Integrity
11. A Native American patient describes a difficult childhood and dropping out of high school.
The patient abused alcohol as a teenager to escape feelings of isolation but stopped 10 years
ago. The patient now says, “I feel stupid. I’ve never had a good job. I don’t help my
people.” Which nursing diagnosis applies?
a. Risk for other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation
ANS: B
The patient has given several indications of chronic low self-esteem. Forming a positive
self-image is often difficult for Native American individuals because these indigenous
people must blend together both American and Native American worldviews. No defining
characteristics are present for the other nursing diagnoses.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 5-6, 20
TOP: Nursing Process: Diagnosis/Analysis
MSC: Client Needs: Psychosocial Integrity
12. Which viewpoint of an Asian American family will most affect decision making about care?
a. The father is the authority figure.
b. The mother is head of the household.
c. Women should make their own decisions.
d. Emotional communication styles are desirable.
ANS: A
Asian American families traditionally place the father in the position of power as the head
of the household. Mothers, as well as other women, are usually subservient to fathers in
these cultures. Asian Americans are more likely to be reserved.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 5-6, 17, 35 (Table 5-5)
TOP: Nursing Process: Planning/Outcomes Identification
MSC: Client Needs: Psychosocial Integrity
13. Which intervention best demonstrates that a nurse correctly understands the cultural needs
of a hospitalized Asian American patient diagnosed with a mental illness?
a. Encouraging the family to attend community support groups
b. Involving the patient’s family to assist with activities of daily living
c. Providing educational pamphlets to explain the patient’s mental illness
d. Restricting homemade herbal remedies the family brings to the hospital
ANS: B
The Asian community values the family in caring for each other. The Asian community uses
traditional medicines and healers, including herbs for mental symptoms. The Asian
community describes illness in somatic terms. The Asian community attaches a stigma to
mental illness, so interfacing with the community would not be appealing.
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PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 5-6, 17, 35 (Table 5-5)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
14. A nurse speaks with family members of a Chinese American parent recently diagnosed with
major depressive disorder. Which comment by the nurse will the family find most
comforting? “The nursing staff will
a. take good care of your parent.”
b. pray with your parent several times a day.”
c. teach your parent important self-care strategies.”
d. educate your parent about safety information regarding medication.”
ANS: A
Chinese Americans hold an Eastern (balance) worldview. Persons who are ill or need health
care are vulnerable and need protection. The family will find comfort in a nurse’s statement
that good care will be provided. The distracters apply to persons with a Western or
indigenous worldview.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Page 5-29 (Table 5-2)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
15. A patient in the emergency department shows a variety of psychiatrical symptoms,
including restlessness and anxiety. The patient says, “I feel sad because evil spirits have
overtaken my mind.” Which worldview is most applicable to this individual?
a. Eastern/balance
b. Southern/holistic
c. Western/scientific
d. Indigenous/harmony
ANS: D
Persons of an indigenous worldview believe disease results from a lack of personal,
interpersonal, environmental, or spiritual harmony and that evil spirits exist. The holism of
body–mind–spirit is a key component of this view. If one believes an evil spirit has taken
control, distress results. Western and Eastern worldviews do not embrace spirits. See
relationship to audience response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 5-29 (Table 5-2)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
16. A nurse prepares to teach important medication information to a patient of Mexican
heritage. How should the nurse manage the teaching environment?
a. Stand very close to the patient while teaching.
b. Maintain direct eye contact with the patient while teaching.
c. Maintain a neutral emotional tone during the teaching session.
d. Sit 4 feet or more from the patient during the teaching session.
ANS: A
Latin American cultures use close personal space, closer than many other minority groups.
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Standing very close to the patient frequently indicates acceptance. Direct eye contact should
not be prolonged with this patient. Persons of this cultural heritage have high emotionality.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-31 (Table 5-3)
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
17. A Chinese American patient diagnosed with an anxiety disorder says, “My problems began
when my energy became imbalanced.” The nurse asks for the patient’s ideas about how to
treat the imbalance. Which comment would the nurse expect from this patient?
a. “My family will bring special foods to help me get well.”
b. “I hope my health care provider will prescribe some medication to help me.”
c. “I think I would benefit from talking to other patients with a similar problem.”
d. “I would like to have a native healer perform a ceremony to balance my energy.”
ANS: A
The concept of energy imbalance as a source of illness is an explanatory model familiar to
Asian cultures. A source of healing is dietary change to include either “hot” or “cold” foods
to correct the imbalance. “Hot” and “cold” in this case do not refer to thermal properties of
the foods. Medication would not be a treatment suggested by a patient with an Eastern
worldview. Someone from an indigenous culture may suggest rituals. Group discussion of
mental illness would not be appealing to a Chinese American.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-29 (Table 5-2)
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
18. An experienced psychiatric nurse plans to begin a new job in a community-based
medication clinic. The clinic sees culturally diverse patients. Which action should the nurse
take first to prepare for this position?
a. Investigate cultural differences in patients’ responses to psychotropic medications.
b. Contact the clinical nurse specialist for guidelines regarding cultural competence.
c. Examine the literature on various health beliefs of members of diverse cultures.
d. Complete an online continuing education offering about psychopharmacology.
ANS: A
An experienced nurse working on a mental health inpatient unit would be familiar with the
action and side effects of most commonly prescribed psychotropic medications. However,
because the clinic serves a culturally diverse population, reviewing cultural differences in
patients’ responses to these medications is helpful and vital to patient safety. The distracters
identify actions the nurse would take later.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Page 5-12
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
19. A psychoeducational session will discuss medication management for a culturally diverse
group of patients. Group participants are predominantly members of minority cultures. Of
the four staff nurses below, which nurse should lead this group?
a. Very young registered nurse
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b. Older, mature registered nurse
c. Newly licensed registered nurse
d. A registered nurse who is very thin
ANS: B
Persons of minority cultures value age and wisdom. Persons with a Western worldview tend
to value youth. An older, mature registered nurse would be the most credible leader of this
group. The nurse’s size has no bearing on credibility.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-33 (Table 5-4)
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
20. A nurse wants to engage an interpreter for a severely anxious 21-year-old male who
immigrated to the United States 2 years ago. Of the four interpreters below who are
available and fluent in the patient’s language, which one should the nurse call?
a. 65-year-old female professional interpreter
b. 24-year-old male professional interpreter
c. A member of the patient’s family
d. The patient’s best friend
ANS: B
A professional interpreter will be most effective because he/she will be able to interpret both
language and culture. When an interpreter is engaged, the interpreter should be matched to
the patient as closely as possible in gender, age, social status, and religion. Interpreters
should not be relatives or friends of the patient. The stigma of mental illness may prevent
the openness needed during the encounter.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 5-8, 33 (Table 5-4)
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
21. A patient who has been hospitalized for 3 days with a serious mental illness says, “I’ve got
to get out of here and back to my job. I get 60 to 80 messages a day, and I’m getting behind
on my email correspondence.” What is this patient’s perspective about health and illness?
a. Fateful, magical
b. Eastern, holistic
c. Western, biomedical
d. Harmonious, religious
ANS: C
The Western biomedical perspective holds the belief that sick people should be as
independent and self-reliant as possible. Self-care is encouraged; one gets better by “getting
up and getting going.” An ability to function at a high level is valued. See relationship to
audience response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 5-35 (Table 5-5)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
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22. A white patient of German descent rocks back and forth, grimaces, and rubs both temples.
What is the nurse’s best action?
a. Assess the patient for extrapyramidal symptoms.
b. Sit beside the patient and rock in sync.
c. Offer to pray with the patient.
d. Assess the patient for pain.
ANS: D
This patient of German descent would hold a Western worldview and be stoic about pain.
This patient will keep pain as silent as possible and be reluctant to disclose pain unless the
nurse actively assesses for it. The patient’s nonverbal communication suggests pain rather
than EPS (extrapyramidal symptoms). The patient would probably not respond positively to
prayer or the nurse’s rocking behavior.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 5-35 (Table 5-5)
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
23. A Vietnamese patient’s family reports that the patient has wind illness. Which menu
selection will be most helpful for this patient?
a. Iced tea
b. Ice cream
c. Warm broth
d. Gelatin dessert
ANS: C
Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population.
It is characterized by a fear of cold, wind, or drafts. It is treated by keeping very warm and
avoiding foods, drinks, and herbs that are cold. Warm broth would be most in sync with the
patient’s culture and provide the most comfort. The distracters are cold foods.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Page 5-38 (Box 5-2)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
24. A Mexican American patient puts a picture of the Virgin Mary on the bedside table. What is
the nurse’s best action?
a. Move the picture so it is beside a window.
b. Send the picture to the business office safe.
c. Leave the picture where the patient placed it.
d. Send the picture home with the patient’s family.
ANS: C
Cultural heritage is expressed through language, works of art, music, dance, customs,
traditions, diet, and expressions of spirituality. This patient’s prominent placement of the
picture is an example of expression of cultural heritage and spirituality. The nurse should
not move it unless the patient’s safety is jeopardized.
PTS: 1
DIF:
REF: Pages 5-3, 16, 19
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Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
25. A nurse begins work in 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.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 5-15, 16
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
26. A nurse cares for a first-generation American whose family emigrated from Germany.
Which worldview about the source of knowledge would this patient likely have?
a. Knowledge is acquired through use of affective or feeling senses.
b. Science is the foundation of knowledge and proves something exists.
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 from science. The
distracters describe the beliefs of other cultural groups. See relationship to audience
response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 5-35 (Table 5-5)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
27. 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 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.
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