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Wilson & Giddens: Health Assessment for Nursing Practice,
4th Edition

Test Bank

Chapter 2: Ethnic and Cultural Considerations

MULTIPLE CHOICE

1. A Hispanic client tells an African American nurse, “You are African American and can’t possibly understand how a person like me feels.” An appropriate response by the nurse is to:
a. Find a nurse who is not African American to interview the client.
b. Ask the client, “Why would you think that, since we just met?”
c. Note that the client is very defensive about being racially different.
d. Encourage the client to describe what he means by “a person like me.”

ANS: D
Correct: By encouraging the client to describe what he means by “a person like me,” the nurse is demonstrating cultural awareness and sensitivity by gathering more data about the unique beliefs and values systems of this client.
Incorrect A: Finding a nurse who is not African American to interview the client is neither necessary nor practical.
Incorrect B: Asking “Why would you think that…” sounds defensive and may not facilitate further communication.
Incorrect C: Making an assumption “that the client is very defensive about being racially different” is not based on any data.

DIF: Cognitive Level: Application REF: 10
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

2. What are the characteristics that comprise “culture”?
a. Color of skin and hair
b. A system of beliefs and practices
c. Personal preferences for child care
d. Language and religion

ANS: B
Correct: “A system of beliefs and practices” is part of the definition of culture.
Incorrect A: Skin and hair color are examples of racial characteristics based on genetics.
Incorrect C: Personal preference for child care is an individual preference unrelated to culture.
Incorrect D: Language and religion are examples of ethnicity.

DIF: Cognitive Level: Comprehension REF: 10
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

3. The statement, “The more full-blooded an American Indian or Alaska Native is, the higher the risk of type 2 diabetes mellitus” is an example of:
a. The genetic code found in the Human Genome Project.
b. A direct relationship between ethnicity and a health variable.
c. A direct relationship between race and a health variable.
d. An indirect relationship between culture and a health variable.

ANS: C
Correct: A direct relationship between race and a health variable is the most accurate because characteristics of genetics and race and the prevalence of health conditions are often correlated with ancestry.
Incorrect A: The Human Genome Project identified differences in genetic codes.
Incorrect B: Ethnicity generally does not correlate with health variables.
Incorrect D: Culture does not include characteristics of genetics and race related to the prevalence of health conditions.

DIF: Cognitive Level: Application REF: 10
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

4. Which data best characterize the client’s race?
a. The language spoken in the client’s home is Tagalog.
b. The client’s family follows a kosher diet.
c. The client and his family have blonde hair and fair skin.
d. The client’s grandparents came to the United States from Germany.

ANS: C
Correct: Blonde hair and fair skin indicate genetics and race.
Incorrect A: The language spoken at home refers to ethnicity.
Incorrect B: A kosher diet refers to ethnicity.
Incorrect D: Although the client and grandparents may share the same race, that the grandparents came to the United States from Germany does not relate to race.

DIF: Cognitive Level: Comprehension REF: 10
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment
MSC: Integrated Process: Nursing Process: Assessment

5. A male nurse is assigned to the care of a homosexual male with alcoholism. To be most effective in interacting with this client, the nurse must first:
a. Determine the client’s degree of risk for contracting the human immunodeficiency virus.
b. Examine his own feelings about alcoholism and homosexuality.
c. Determine how much and how often the client is consuming alcohol.
d. Recognize that the client’s health beliefs and practices should not differ from the nurse’s.

ANS: B
Correct: Generally part of the process for developing cultural competence involves examining one’s own feelings about alcoholism and homosexuality specifically and identifying one’s own beliefs and values, which should allow one to recognize the uniqueness of clients and to demonstrate respect for individuals.
Incorrect A: Determining the client’s degree of risk for contracting the human immunodeficiency virus is based on an assumption that because the client is homosexual, he has or will have the human immunodeficiency virus.
Incorrect C: Determining how much and how often the client is consuming alcohol does not assist the nurse in being more effective in interacting with this client.
Incorrect D: Believing a client’s beliefs and practices should not differ from the nurse’s is the opinion of a nurse who is not culturally competent.

DIF: Cognitive Level: Application REF: 11
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment
MSC: Integrated Process: Nursing Process: Assessment

6. Culturally-competent care includes what behavior?
a. Recognizing that there are different definitions of health and illness
b. Complying with the stated plan of treatment, despite the client’s differing opinion
c. Understanding that there is diversity even among people of the same cultural group
d. Helping clients of different cultures adopt the beliefs and behaviors of the dominant culture

ANS: C
Correct: Understanding that there is diversity even among people of the same cultural group prevents assumptions and stereotypes that inhibit culturally-competent care.
Incorrect A: Recognizing that there are many different definitions of health and illness is not sufficient for culturally competent care. The nurse needs to have an understanding of the diversity among people.
Incorrect B: Complying with the stated plan of treatment despite the client’s differing opinion is not a culturally-competent behavior. The client needs to understand, support, and participate in the plan of care.
Incorrect D: Helping clients of different cultures adopt the beliefs and behaviors of the dominant culture is an example of the opposite of cultural competence; it assumes that all persons should adopt certain beliefs and behaviors.

DIF: Cognitive Level: Application REF: 11
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

7. A nurse is working with an interdisciplinary group to write procedures for effective and efficient assessment of clients from a multiracial inner city population. One guideline states, “Remember that all Hispanic clients will be unwilling to give personal medical information to a stranger.” This statement is an example of:
a. Racial discrimination.
b. Ethnic diversity.
c. Cultural sensitivity.
d. Cultural stereotyping.

ANS: D
Correct: This is an example of cultural stereotyping; which is defined as the assumption that all clients of a particular culture and background have the same beliefs, values, and behaviors. Cultural stereotyping is also called racial profiling.
Incorrect A: Racial discrimination is the belief that one race is superior or inferior to members of other races.
Incorrect B: Ethnic diversity acknowledges the differences among clients who are of a different ethnicity from the nurse.
Incorrect C: Cultural sensitivity acknowledges the unique beliefs and value systems of individuals of other cultures and backgrounds.

DIF: Cognitive Level: Comprehension REF: 11
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

8. A nurse is conducting a cultural assessment of a 38-year-old American Indian woman who has come to the clinic complaining of persistent headaches. The client tells the nurse that the medicines prescribed by the tribal healer have done “some good.” The appropriate response of the nurse is to:
a. Advise the client to stop taking any non-prescription medicines.
b. Tell the client to increase the frequency of the healer’s medicines.
c. Ask the client about these medicines and how often the client uses them.
d. Tell the physician that the client probably has headaches caused by the healer’s medicines.

ANS: C
Correct: Asking the client about the nature of these medicines and how often the client uses them allows the nurse to collect data about the medicines and their uses, to learn more about the practices used by this client to improve her health, and to check for potential drug interaction before prescribing other medications or treatment.
Incorrect A: Advising the client to stop taking any non-prescription medicines is inappropriate until the nurse knows details about all medicines used by the client.
Incorrect B: Telling the client to increase the frequency of the healer’s medicines is inappropriate until the nurse knows details about the medicines.
Incorrect D: Telling the physician that the client probably has headaches caused by the healer’s medicines is inappropriate until the nurse knows details about the medicines.

DIF: Cognitive Level: Application REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

9. Which statement allows the nurse to work effectively with an ill client from another culture?
a. “You can read English, can’t you?”
b. “What practices do you believe will help make you well?”
c. “If you will do what the doctor prescribes, you will get better.”
d. “It will be important for you to have strong faith in these medicines.”

ANS: B
Correct: Asking “What practices do you believe will help make you well?” allows the nurse to learn more about the client and the client’s wellness practices to individualize nursing care.
Incorrect A: The question “You can read English, can’t you?” communicates an expectation of language and does not consider the client’s culture.
Incorrect C: The comment “If you will do what the doctor prescribes, you will get better” does not consider the client’s culture.
Incorrect D: “It will be important for you to have strong faith in these medicines” advises the client about how to react to treatment.

DIF: Cognitive Level: Analysis REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

10. An appropriate way to determine the client’s religious practices would be to ask:
a. “How often do you go to church?”
b. “Where is your church located?”
c. “You wouldn’t mind telling me about your religion, would you?”
d. “Do you have any specific religious or spiritual practices or beliefs?”

ANS: D
Correct: “Do you have any specific religious or spiritual practices or beliefs?” is a broad, open-ended question that allows the client to describe his or her religious beliefs. The question makes no reference to any particular faith.
Incorrect A: Asking the client about his or her church makes the assumption that the client worships in a church, which may not be correct.
Incorrect B: Asking the client about the location of his or her church makes the assumption that the client worships in a church, which may not be correct.
Incorrect C: The question “You wouldn’t mind telling me about your religion, would you?” yields a “yes” or “no” response and is worded in a negative way.

DIF: Cognitive Level: Application REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Religious and Spiritual Influences on Health TOP: Adult Health: Cultural Assessment
MSC: Integrated Process: Nursing Process: Assessment

11. A client tells the nurse that her religion prohibits her from eating food prepared outside of a special kitchen. The nurse’s appropriate response is to:
a. Call the dietary department to cancel the client’s meal tray.
b. Tell the client that her diet must be carefully monitored and prepared at the hospital.
c. Inform the client that during her illness a few changes can be made to her religious requirements.
d. Ask the client to describe the requirements for the special kitchen.

ANS: D
Correct: Asking the client to describe the requirements for the special kitchen allows the nurse to collect more data about the needs of the client.
Incorrect A: Cancelling the client’s food tray is inappropriate because it does not meet the client’s needs.
Incorrect B: Telling the client that her diet must be carefully monitored and prepared at the hospital is inappropriate because it does not consider the ethnicity of the client and is not culturally-competent care.
Incorrect C: Informing the client that during her illness a few changes can be made to her religious requirements is inappropriate because asking the client to change her religious requirements does not respect her ethnicity and is not culturally-competent care.

DIF: Cognitive Level: Application REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Religious and Spiritual Influences on Health TOP: Adult Health: Cultural Assessment
MSC: Integrated Process: Caring

12. Which question would be most effective in assessing a client’s personal beliefs about health and illness?
a. “What or who do you believe controls your health?”
b. “Do you see your health care provider annually?”
c. “In what language do you think?”
d. “Who makes the decisions in your family?”

ANS: A
Correct: “What or who do you believe controls your health?” is a broad question that allows the client to describe his or her beliefs.
Incorrect B: Asking if the client visits his or her health care provider annually assumes the client has a health care provider, and it is a closed-ended question that yields little data.
Incorrect C: Asking about the language the client uses when thinking is information the nurse may need, but it is not directly related to health.
Incorrect D: Asking who makes decisions in the client’s family may be important information to gather, but it is not directly related to health.

DIF: Cognitive Level: Comprehension REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Religious and Spiritual Influences on Health TOP: Adult Health: Cultural Assessment
MSC: Integrated Process: Nursing Process: Assessment

13. An Asian woman comes to the clinic with a complaint of back pain. During the history interview, she tells the nurse that she usually uses acupuncture for her ailments. What is the nurse’s best response?
a. “When have you used acupuncture, and what effects did it have?”
b. “Acupuncture is good for some problems, but for major illnesses it’s best to see a doctor.”
c. “Why did you use acupuncture?”
d. “I hear that lots of Asian people use acupuncture.”

ANS: A
Correct: Asking about the use and effectiveness of acupuncture acknowledges the client’s choice of treatment and allows the nurse to gather more data about its effectiveness for this client.
Incorrect B: Stating that acupuncture is not effective for major illnesses is a non-therapeutic response, not necessarily true, and criticizes/judges the client’s choice of treatment.
Incorrect C: Asking the client why acupuncture was used is a non-therapeutic response and questions the client’s reason for her health care decisions.
Incorrect D: Commenting that “I hear that lots of Asian people use acupuncture” is an example of stereotyping.

DIF: Cognitive Level: Analysis REF: 10, 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring: Assessment

14. A nurse is caring for a woman who has given birth to a healthy baby. The woman’s husband and mother are in the room, and more family members are in the lobby. To provide culturally-competent care, the nurse says:
a. “We need to take your baby to the nursery now for a physical examination.”
b. “Are there any ceremonies or other practices that would be important to occur at this time?”
c. “We can only allow immediate family in the room with you at this time.”
d. “Because breast-feeding is the best way to feed your baby, we’ll bring your baby to you when she is hungry.”

ANS: B
Correct: Asking about ceremonies or other practices collects data about culturally-based behaviors of this client and family surrounding childbirth.
Incorrect A: Although a physical exam is important, it is not necessary for culturally-competent care and can be performed at another time.
Incorrect C: Limiting visitors based on an arbitrary or subjective definition of “immediate family” may interfere with culturally-competent care.
Incorrect D: Breast feeding is a choice the mother makes, not the nurse.

DIF: Cognitive Level: Application REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Intervention
MSC: Integrated Process: Nursing Process: Assessment

15. A nurse can improve cultural awareness with which behavior?
a. Developing sensitivity to the differences between the nurse’s culture and the client’s
b. Making generalizations about various ethnic and cultural groups
c. Learning everything about the various cultural groups in the nurse’s city
d. Taking a foreign-language class

ANS: A
Correct: Developing sensitivity to differences between the nurse’s and the client’s cultures allows the nurse to be open and to collect data about each unique client.
Incorrect B: Making generalizations about various ethnic and cultural groups leads to stereotyping.
Incorrect C: Learning everything about the various cultural groups in the nurse’s city provides useful information about a specific city, but does not necessarily improve cultural awareness of cultures in other cities.
Incorrect D: Learning a foreign language may help a nurse learn information about one culture, but does not improve cultural awareness of other cultures.

DIF: Cognitive Level: Comprehension REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Caring

COMPLETION

1. During the first prenatal visit for a 20-year-old Hispanic woman, the nurse assesses the client’s health beliefs and practices. Which questions are appropriate as part of this assessment? ________________ (Your answer should appear as numbers separated by commas and spaces [e.g., 1, 2, 3, 4].)
1. “Because all Hispanics speak Spanish, do you need me to find a translator?”
2. “What is the language that is usually spoken in your home?”
3. “How do you define health and illness?”
4. “Which Catholic church do you attend?”
5. “Do you have specific beliefs or preferences concerning food or food preparation?”
6. “Do you or the members of your family have certain beliefs and practices surrounding pregnancy and childbirth?”

ANS:
2, 3, 5, 6
Correct: The appropriate questions are (2) “What is the language that is usually spoken in your home?” (3) “How do you define health and illness?” (5) “Do you have specific beliefs or preferences concerning food or food preparation?” and (6) “Do you or the members of your family have certain beliefs and practices surrounding pregnancy and childbirth?” These four questions support culturally-sensitive nursing care.
Incorrect 1: The question “Because all Hispanics speak Spanish, do you need me to find a translator?” assumes that all Hispanic persons speak Spanish only and is an example of stereotyping.
Incorrect 4: The question “Which Catholic church do you attend?” assumes that all Hispanics are Catholics and is an example of stereotyping.

DIF: Cognitive Level: Analysis REF: 12
OBJ: NCLEX Client Need Category: Psychosocial Integrity: Cultural Diversity
TOP: Adult Health: Cultural Assessment MSC: Integrated Process: Nursing Process