Chapter 05: Cultural Implications
Halter: Varcarolis’ Foundations of Psychiatric-Mental Health Nursing: A Clinical
Approach, 9th Edition
MULTIPLE CHOICE
1. Which Western cultural feature may result in establishing
unrealistic outcomes for clients of other cultural groups?
Interdependence
Present orientation
Flexible perception of time
Direct confrontation to solve problems
a.
b.
c.
d.
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 clients should take direct
action. Clients 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)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
2. A psychiatric nurse leads a medication education group for Hispanic clients. This nurse holds
a Western worldview and uses pamphlets as teaching tools. Groups are short and concise.
After the group, the clients 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)
TOP: Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
3. To provide culturally competent care, the nurse should focus on what action?
a. accurately interpreting the thinking of individual clients.
b. predicting how a client may perceive treatment interventions.
c. formulating interventions to reduce the client’s ethnocentrism.
d. identifying strategies that fit within the cultural context of the client.
ANS: D
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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 clients find acceptable and helpful.
Interpreting the thinking of individual clients does not ensure culturally competent care.
Reducing a client’s ethnocentrism may not be a desired outcome.
PTS: 1
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning | Nursing Process: Outcomes Identification
MSC: Client Needs: Psychosocial Integrity
4. A black client, originally from Haiti, has a diagnosis of major depressive disorder. A colleague
tells the nurse, “This client often looks down and is reluctant to share feelings. However, I’ve
observed the client spontaneously interacting with other clients of color.” Select the nurse’s
best response.
a. “Clients of color depend on the church for support. Have you consulted the
client’s pastor?”
b. “Encourage the client to talk in a group setting. It will be less intimidating than
one-to-one interaction.”
c. “Don’t take it personally. Clients of color often have a resentful attitude that takes
a long time to overcome.”
d. “The client may have difficulty communicating in English. Have you considered
using a cultural broker?”
ANS: D
Society expects a culturally diverse client 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)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. A Haitian client 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 client is demonstrating what?
a. Delusions of persecution.
b. A misdiagnosed of depression.
c. The believe that distress is the result of a curse or spell.
d. Feelings of 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 client with
depression as having schizophrenia.
PTS: 1
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
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6. A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A client, who
was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best
explains this behavior?
a. The client wants to lead the group and give directions to others.
b. The client wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The client does not want to be late.
d. The behavior indicates feelings of self-importance that the client 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 client’s military experience represents an aspect of
the client’s behavior. The military culture values timeliness. The distracters represent
misinterpretation of the client’s behavior and have no bearing on the situation.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
7. A nurse in the clinic has a full appointment schedule. A Hispanic American client arrives at
1230 for a 1000 appointment. A Native American client does not keep an appointment at all.
What understanding about the clients will improve the nurse’s planning?
a. They are members of cultural groups that have a different view of time.
b. They are immature and irresponsible in health care matters.
c. They are acting-out feelings of anger toward the system.
d. They are 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 client’s present orientation.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
8. The sibling of an Asian American client tells the nurse, “My sister needs help for pain. She
cries from the hurt.” Which understanding regarding persons of an Asian American heritage
will help the nurse contribute to culturally competent care for this client?
a. They often express emotional distress with physical symptoms.
b. They will probably respond best to a therapist who is impersonal.
c. They will require prolonged treatment to stabilize these symptoms.
d. They should be given direct information about the diagnosis and prognosis.
ANS: A
Asian Americans commonly express psychological distress as a physical problem. The client
may believe psychological problems are caused by a physical imbalance. Treatment will likely
be short. The client 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.
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PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
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 client?
a. Open and friendly; ask direct questions; touch the client’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
clients of a Western orientation.
PTS: 1
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
10. A Native American client sadly describes a difficult childhood. The client abused alcohol as a
teenager but stopped 10 years ago. The client now says, “I feel stupid and good for nothing. I
don’t help my people.” How should the treatment team focus planning for this client?
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 client 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)
TOP: Nursing Process: Planning | Nursing Process: Outcomes Identification
MSC: Client Needs: Psychosocial Integrity
11. A Native American client describes a difficult childhood and dropping out of high school. The
client abused alcohol as a teenager to escape feelings of isolation but stopped 10 years ago.
The client 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
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The client has given several indications of chronic low self-esteem. Forming a positive selfimage 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)
TOP: Nursing Process: Diagnosis | Nursing Process: 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)
TOP: Nursing Process: Planning | Nursing Process: 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 client diagnosed with a mental illness?
Encouraging the family to attend community support groups
Involving the client’s family to assist with activities of daily living
Providing educational pamphlets to explain the client’s mental illness
Restricting homemade herbal remedies, the family brings to the hospital
a.
b.
c.
d.
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.
PTS: 1
DIF: Cognitive Level: Apply (Application)
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 take good care of your parent.”
“The nursing staff will pray with your parent several times a day.”
“The nursing staff will teach your parent important self-care strategies.”
“The nursing staff will educate your parent about safety information regarding
medication.”
a.
b.
c.
d.
ANS: A
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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)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
15. A client in the emergency department shows a variety of psychiatric symptoms, including
restlessness and anxiety. The client 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)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
16. A nurse prepares to teach important medication information to a client of Mexican heritage.
How should the nurse manage the teaching environment?
Stand very close to the client while teaching.
Maintain direct eye contact with the client while teaching.
Maintain a neutral emotional tone during the teaching session.
Sit 4 feet or more from the client during the teaching session.
a.
b.
c.
d.
ANS: A
Latin American cultures use close personal space, closer than many other minority groups.
Standing very close to the client frequently indicates acceptance. Direct eye contact should not
be prolonged with this client. Persons of this cultural heritage have high emotionality.
PTS: 1
DIF: Cognitive Level: Apply (Application)
MSC: Client Needs: Health Promotion and Maintenance
17. A Chinese American client diagnosed with an anxiety disorder says, “My problems began
when my energy became imbalanced.” The nurse asks for the client’s ideas about how to treat
the imbalance. Which comment would the nurse expect from this client?
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 clients with a similar problem.”
d. “I would like to have a native healer perform a ceremony to balance my energy.”
ANS: A
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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 client 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)
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 clients. Which action should the nurse take first to
prepare for this position?
a. Investigate cultural differences in clients’ 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
clients’ responses to these medications is helpful and vital to client safety. The distracters
identify actions the nurse would take later.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
19. A psychoeducational session will discuss medication management for a culturally diverse
group of clients. 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
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)
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 client’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 client’s family
d. The client’s best friend
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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
client as closely as possible in gender, age, social status, and religion. Interpreters should not
be relatives or friends of the client. The stigma of mental illness may prevent the openness
needed during the encounter.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
21. A client 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 client’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)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
22. A client of German descent rocks back and forth, grimaces, and rubs both temples. What is the
nurse’s best action?
Assess the client for extrapyramidal symptoms.
Sit beside the client and rock in sync.
Offer to pray with the client.
Assess the client for pain.
a.
b.
c.
d.
ANS: D
This client of German descent would hold a Western worldview and be stoic about pain. This
client will keep pain as silent as possible and be reluctant to disclose pain unless the nurse
actively assesses for it. The client’s nonverbal communication suggests pain rather than EPS
(extrapyramidal symptoms). The client would probably not respond positively to prayer or the
nurse’s rocking behavior.
PTS: 1
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
23. A Vietnamese client’s family reports that the client has wind illness. Which menu selection
will be most helpful for this client?
Iced tea
Ice cream
Warm broth
Gelatin dessert
a.
b.
c.
d.
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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
client’s culture and provide the most comfort. The distracters are cold foods.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
24. A Mexican American client puts a picture of the Virgin Mary on the bedside table. What is the
nurse’s best action?
Move the picture so it is beside a window.
Send the picture to the business office safe.
Leave the picture where the client placed it.
Send the picture home with the client’s family.
a.
b.
c.
d.
ANS: C
Cultural heritage is expressed through language, works of art, music, dance, customs,
traditions, diet, and expressions of spirituality. This client’s prominent placement of the
picture is an example of expression of cultural heritage and spirituality. The nurse should not
move it unless the client’s safety is jeopardized.
PTS: 1
DIF: 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 by initially
providing what intervention?
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)
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 client likely have?
Knowledge is acquired through use of affective or feeling senses.
Science is the foundation of knowledge and proves something exists.
Knowledge develops by striving for transcendence of the mind and body.
Knowledge evolves from an individual’s relationship with a supreme being.
a.
b.
c.
d.
ANS: B
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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)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
27. The nurse administers medications to a culturally diverse group of clients on a psychiatric
unit. What expectation should the nurse have about pharmacokinetics?
a. Clients 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 clients 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.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
28. A nurse prepares to assess a newly hospitalized client who moved to the United States 6
months ago from Somalia. What should the nurse initially determine?
if the client’s immunizations are current.
the client’s religious preferences.
the client’s specific ethnic group.
whether an interpreter is needed.
a.
b.
c.
d.
ANS: D
The assessment depends on communication. The nurse should first determine whether an
interpreter is needed. The other information can be subsequently assessed.
PTS: 1
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which questions should the nurse ask to determine an individual’s worldview? (Select all that
apply.)
What is more important: the needs of an individual or the needs of a community?
How would you describe an ideal relationship between individuals?
How long have you lived at your present residence?
Of what importance are possessions in your life?
Do you speak any foreign languages?
a.
b.
c.
d.
e.
ANS: A, B, D
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