cultural Diversity in Health and Illness

TEXTBOOK  Cultural Diversity in Health and Illness

  8th Edition, 2013 ISBN-13: 9780132840064

AUTHOR  Rachel E. Spector


Multiple Choice Questions

1. The nurse desires to become more culturally competent when providing care to patients from

non-English- speaking cultures. Which action would the nurse take to achieve this self-


a. Commit to a time-consuming journey

b. Find a seminar on cultural competence

c. Talk to people from different cultures

d. Attend a festival from a different culture

2. The staff development educator is analyzing ways to incorporate cultural competency concepts

in continuing education programs. How will the educator explain the concept of cultural

competency to staff?

a. Philosophy

b. Condition

c. Theory

d. Fad

3. A health care organization is planning continuing education for all staff on culturally and

linguistically appropriate service delivery. Which category of culturally and linguistically

appropriate services in health care will this action support?

a. Fundamentals of culturally competent care

b. Speaking of culturally competent care

c. Structuring culturally competent care

d. Manage the dynamics of difference

4. The nurse is unable to locate an interpreter to support a patient from a non-English-speaking

culture. The patient asks a family member to interpret for the staff. What would the nurse do to

ensure culturally and linguistically appropriate services for this patient?

a. Use sign language.

b. Write the questions down for the patient to answer.

c. Do nothing until an interpreter can be located.

d. Use the family member as an interpreter until a non–family member can be located.

5. A patient from a non-English-speaking culture comes into the health clinic seeking care. The

nurse is unable to determine the patient’s primary language. What should the nurse do?

a. Notify Security

b. Encourage the patient to seek care elsewhere

c. Ask for help to determine the patient’s primary language

d. Contact a homeless shelter

6. In a non-English-speaking patient’s medical records, it is indicated that he has no family.

However, a large group of people stating that they are the patient’s family have just arrived to

the critical care unit. What impact does this miscommunication have on the patient’s care?

a. Increase the cost

b. Poor decision making

c. Improve the outcomes

d. Enhance therapeutic communication

7. The nurse working in a Joint Commission–accredited organization is admitting a patient from a

non-English- speaking culture. Which action supports the Joint Commission principle of

effective communication?

a. Manage the dynamics of difference

b. Value diversity

c. Assess communication needs

d. Adapt to diversity

8. The nurse determines that a patient is in the process of acculturation. What did the nurse

assess in this patient?

a. Americanization of the patient’s name

b. Engaging in activities with members of the family’s preferred social group

c. Speaking the family’s native language

d. Living away from the family of origin

9. A patient born in a European country speaks excellent American English. The nurse realizes that

this patient has achieved which type of assimilation?

a. Marital

b. Cultural

c. Primary structural

d. Secondary structural

10. The nurse is planning care for an older patient. What will the nurse take into consideration to

reduce generational conflict?

a. Events that occurred when the patient was 10 years of age

b. Ethnocultural status of the nurse

c. Age of the nurse

d. All of the above.

11. A seminal event in the boomer generation that can still elicit comments today is the question:

a. “Where were you when John F. Kennedy was shot?”

b. “Do you remember Pearl Harbor?”

c. “What were you doing on September 11, 2001?”

d. “How did the Challenger tragedy affect you?”

12. The staff development instructor is planning a seminar that focuses on the variables leading to

generational conflict. What will the instructor include in this content?

a. Decade of birth

b. Generation in the United States

c. Class

d. All of the above.

13. A health care provider comments that a patient is “too old to take care of herself” and needs

to “let a man make decisions for her.” The nurse recognizes that this health care provider is

demonstrating which misanthropic feelings?

a. Ethnocentrism

b. Sexism

c. Racism

d. Heterosexism

14. According to the 2010 Census, 40.3 million people are aged 65 and over. What are the

long-term implications for the health of this group?

a. Providing health care that is focused on gerontological needs

b. Developing medications to prolong life at any cost

c. Providing health insurance for all age groups

d. Developing systems to provide health care only to those older citizens who remain


15. A patient, an immigrant from another country, is waiting to be seen in the Emergency

Department. What difficulties is this patient dealing with since coming to a new country?

a. Learning a new language

b. Adapting to a new climate

c. Eating new foods

d. All of the above.

16. The nurse notes that a larger number of foreign-born patients are being seen in the hospital.

From which leading country are the majority of foreign-born, legal permanent residents?

a. Europe

b. Mexico

c. South America

d. None of the above.

17. Legal permanent residents tend to initially settle in urban areas. What can be inferred from


a. Employment may be found but will probably be in lesser-paying jobs

b. Unemployment will not be a concern

c. Employment is easy to obtain in urban areas

d. Income earning potential is higher

18. The nurse desires employment in a metropolitan area with a high percentage of foreign-born

legal residents. In which areas would the nurse consider employment?

a. New York City

b. Los Angeles

c. Miami

d. All of the above.

19. The nurse is trying to determine if a patient is a refugee. Which characteristics would the

patient need to fulfill in order to be classified as a refugee?

a. Person is outside the country of nationality

b. Person is unable to return to the country of nationality because of persecution

c. Person is unable to return to the country of nationality because of fear of persecution

d. All of the above.

20. What disease prevention and health promotion determinants would the nurse review when

assessing a patient?

a. Learn the patient’s lifestyle

b. Understand the patient’s environment

c. Identify how to measure progress

d. a and b only

21. Besides being important public health issues and motivating people to action, what purpose do

the Healthy People 2020 objectives serve?

a. Measure the impact of prevention activities

b. Provide monetary worth to the nation

c. Replace other tools

d. Identify people needing secondary health services

22. Why would health care providers refer to Healthy People 2020 when providing patient care?

a. It serves as a monitoring system that evaluates the health of all citizens.

b. It supports health policies that provide monetary incentives to states who reach the

benchmark goals.

c. It provides a plan to continue to improve the health of everyone in the United States.

d. It is mandated legislation that will result in a healthier population by 2020.

23. While reviewing the Healthy People 2020 document, the nurse identifies what as being the

main objectives of the program?

a. Ensuring that all Americans have one physical each year

b. Emphasize an ecological approach to disease prevention and health promotion.

c. Ensuring that all Americans have health insurance

d. Eliminating childhood diseases

24. Within the Healthy People 2020 document, what characteristics contribute to health disparity

in the United States?

a. Race

b. Religion

c. Gender

d. All of the above.

25. What is the Healthy People 2020 goal for health disparities?

a. Achieve health equity, eliminate disparities, and improve the health of all groups.

b. Reduce health disparities among Americans.

c. Eliminate health disparities among Americans.

d. Recognize health disparities among elderly.

Multiple Choice Questions

1. While assessing a patient from the Jewish culture, the nurse learns that the patient believes that an illness is being caused by another soul. What is this health belief considered?

a. Aberglobin

b. Kayn aynhoreh

c. Szatan

d. Dybbuk

2. While caring for an infant of Puerto Rican descent, the nurse sees a black amulet on a chain on the wrist of the baby’s right hand. What should the nurse do with the amulet?

a. Remove the amulet

b. Leave it on the baby’s wrist

c. Ask that the amulet be removed until the baby is older

d. Move it to the baby’s ankle

3. During an assessment, a patient tells the nurse, “An onion a day keeps everyone away.” How does this philosophy protect health?

a. Protects the person from coming in contact with those who might be ill

b. Affirms the belief in the power of onions to prevent disease

c. Recognizes the special antibiotic properties contained within onions

d. Advertises that onions have special healing abilities

4. While caring for a patient from the Chinese culture, the nurse learns that the patient has a specific practice that follows yin and yang. What impact will this have on the patient’s dietary intake?

a. There are specific foods for specific purposes

b. Some foods are only eaten at different times of the year

c. The patient will eat only specified proportions of food

d. Identifies if foods should be eaten hot or cold

5. Which patient statement reflects a spiritual belief that defines illness?

a. ”I am being punished for breaking a religious code”

b. “It is a necessary part of my religious culture”

c. “I failed to wear special amulets to ward it off”

d. “I am sick because I violated dietary practices”

6. During a health history, a patient tells the nurse about following traditional epidemiological practices. What is the purpose of these practices?

a. Uses folk medicine herbal remedies

b. Used as a part of the patient’s religion

c. Used to cure an illness

d. Used to preserve a heritage

7. The nurse learns that a patient used to follow homeopathic medicine but now only uses allopathic medicine approaches. What is the significance of allopathic medicine?

a. Is practiced only where it is accepted

b. Accepts other forms of therapy as valid for treating disease

c. Empirical science and scientific methods for treating disease

d. Encompasses different treatment modalities within its framework

8. A patient with a progressive neurological disease wants to visit shrines in the United States to offer prayers for healing. Which shrines would be available for the patient to visit?

a. The Tomb of Menachem Mendel Schneerson

b. Shrine of Our Lady of San Juan

c. Shrine of our Lord of Esquipulas

d. All of the above.

9. A patient with terminal cancer is planning a trip to Lourdes, France, the site of a revered Roman Catholic shrine. What is the significance of visiting this shrine?

a. Receiving a cure through a miracle

b. Being able to live a long life

c. Becoming more prosperous

d. Gaining insight about the cause of disease

10. What would be alternative treatment modalities used during an illness?

a. Willingness to seek a second medical opinion

b. Consultation of a healer outside the medical establishment

c. Refusal to allow any medical treatment to be performed

d. Strict adherence to the prescribed medical regimen

11. A patient adheres to the teachings of Seventh-day Adventist. What practice is followed by

those within this religion?

a. Abstinence from alcohol, coffee, and tea

b. Avoid pork

c. Fasting once a month

d. Follow a vegetarian diet

12. A patient tells the nurse that no blood or blood products will be accepted as a form of health

treatment. This patient is most likely a member of which religion?

a. Jehovah’s Witness

b. Roman Catholic

c. Church of Jesus Christ of Latter-day Saints

d. Christian Science

13. A patient follows the teachings of Christian Science and will not take any medications, but for

which health problem will medications be used by members of this religion?

a. Antibiotics

b. Chemotherapy to treat cancer

c. Immunizations to comply with civil law

d. Narcotics for pain relief

14. Which actions are considered to be health restoration practices for individuals of Eastern

European Jewish heritage?

a. Chicken soup

b. Glass of wine

c. Alcohol massage

d. All of the above.

15. A patient tells the nurse about using cod liver oil every day. Which heritages utilize cod liver oil

as a health maintenance practice?

a. English Episcopal

b. English Baptist

c. Norwegian Lutheran

d. a and c only

16. Which health restoration practice for a cold would the nurse assess in a patient of English

Catholic heritage?

a. Rubbing the chest with Vicks

b. Drinking honey and vinegar

c. Gargling with water and vinegar

d. Drinking warm milk

17. During an assessment, the nurse asks a patient of Irish Catholic heritage to identify a health

protection practice that is ingested. What practice will this patient most likely follow?

a. Senna tea

b. Yeast

c. Wine

d. Hot peppermint tea

18. A patient of Swedish-American Protestant descent wants a specific HEALTH protection

intervention to maintain throat health. Which action will the patient most likely request?

a. Gargling with salt and taking honey with milk

b. Having the throat blessed on St. Blaise Day

c. Ingesting baking soda

d. Staying in a steamy bathroom when the throat is sore

19. A patient tells the nurse that Father John’s Medicine is used as a HEALTH protection practice

from November to May. Individuals from which heritage uses this remedy?

a. Italian-American Catholics

b. English-American Episcopalians

c. Canadian Catholics

d. Native American Baptists

20. The cost of prescription medications, an indicator of health care costs, has skyrocketed from

$2.7 million in 1960 to $234.1 billion in 2008. What would be a reason for the increase in

prescription medication costs?

a. Technology costs associated with new drug development

b. Health insurance covers all medication costs

c. People want more prescription medications for all of their illnesses

d. The majority of prescription medications are used by an increasingly aging population

21. The nurse is reviewing the costs associated with providing care for specific health problems in

2006. Which health problems increased since 1999?

a. Respiratory intubation and mechanical ventilation

b. Percutaneous transluminal coronary angioplasty (PTCA)

c. Cardiac pacemaker

d. All of the above.

22. What was the focus of health care during the early part of the twentieth century?

a. Discovery of external cardiac pacing

b. Maternal and child health

c. Implementing Medicare

d. Reducing the impact of HIV/AIDS

23. What was the impact of infrastructure on the health care industry in the middle of the

twentieth century?

a. Development of the foundation for today’s costly tests and treatments

b. Restriction of public immunizations and medications for communicable diseases

c. Social policy planning for health care expenditures

d. Decrease of hospital building and local resources for health care

24. What impact did social and health policy have on the health care system in the latter part of

the twentieth century?

a. Affordable health care for all citizens

b. The majority of health care being paid for through government subsidies

c. Exploding health care costs and the challenges to reform and control them

d. Health care costs decreasing as a result of social and health policy

25. What was the goal of health care reform efforts in the 1990s?

a. Making health care affordable, comprehensive, and accessible

b. Allocating health resources based on priority needs

c. Providing government-subsidized health care

d. Ensuring all citizens had health insurance

Multiple Choice Questions

1. The nurse is observing a healing ceremony performed by people of the American Indian culture. What is a characteristic of this ceremony?

a. Sound

b. Quiet

c. Herbal teas

d. Hallucinogenic plants

2. A patient of the American Indian culture tells the nurse that the medicine man is consulted when an illness develops. How does a person become a medicine man?

a. Know the interrelationships between people, the earth, and the universe

b. Understand the ways of plants and animals

c. Perform special ceremonies

d. All of the above.

3. What is the difference between the modern physician and the medicine man when determining the cause of an illness?

a. The medicine man looks for the physical cause of the problem

b. The medicine man looks for the spiritual cause of the problem

c. The medicine man studies the patient’s past medical history to determine the cause of

the illness

d. The medicine man studies the dietary practices of the person being seen

4. In which American Indian tribe are meditation and herbs used to create a trance to provide the vision of the evil that causes an illness?

a. Hopi

b. Sioux

c. Navajo

d. Cherokee

5. Which Navajo American Indian divination method will women practice to diagnose the cause of a disease?

a. Singing

b. Listening

c. Motion in the hand

d. Stargazing

6. What is the purpose of sand paintings when diagnosing illness in the Navajo American Indian culture?

a. Creates symbolic representations of the client and family

b. Ensures that appropriate payment is made by the family

c. Provides an atmosphere of calm for the medicine man

d. Determines the cause and treatment of the illness

7. The nurse is conducting a medication history with a patient from the Oneida American Indian culture. Which remedies would the nurse include as part of this history?

a. Witch hazel

b. Comfrey

c. Skunk oil

d. All of the above.

8. A patient that is of the American Indian culture is waiting to be seen in a non-Indian Health Service facility. What concern might this patient have about receiving health care through this route?

a. Conflict between his or her perception of the illness and what the physician diagnoses

b. Easier to receive medical care through emergency departments rather than private


c. Receive better health care from mainstream medical services

d. Concern that medical insurance won’t cover all the medical costs

9. Which action would the nurse take when assessing a patient of American Indian culture?

a. Remaining quiet and recognizing the importance of nonverbal communication to seek


b. Asking detailed questions regarding the presenting symptoms

c. Asking indirect questions about the reason for seeking health care

d. Ensuring that no one beyond the medical provider and the client discuss what has

brought the client to seek care

10. Which is a concept of holism in traditional Chinese medicine?

a. Integration of the body with the external environment

b. Energy fields that create health or disease

c. Local pathology as separate from the body

d. Harmonic balance that creates illness

11. Which action would a patient, who practices Ayurvedic medicine, take to reestablish harmony

and balance in the body?

a. Sit in the sun

b. Massage

c. Do yoga and meditation

d. Ingest a substance to cleanse the body of substances that cause disease

12. The nurse is planning care for a group of community members who follow Ayurveda medicine.

What beliefs about this form of health care would the nurse need to keep in mind while

planning this care?

a. All things in the universe are joined together.

b. Human beings contain elements that can be found in the universe.

c. All people are born in a state of balance.

d. All of the above.

13. A patient of the Asian culture tells the nurse that an alteration in yin and yang will lead to

disease. Which variable can affect the body’s yin and yang?

a. Clothing

b. The weather

c. Social class

d. Improper food preparation

14. Why does the Chinese physician focus on palpating a patient’s pulse?

a. It is considered the storehouse of the blood.

b. It indicates a specific treatment.

c. It can help to refine a diagnosis.

d. It determines the time of death.

15. A belief of Ayurvedic medicine is the concept of doshas. What is a characteristic of this


a. Combine space and air to control nutritional preferences

b. Blend fire and water to balance mental capacities

c. Are constantly formed and reformed by food, activity, and bodily processes

d. Use water and earth to regulate hormonal balance

16. While assessing the health history of a patient who is an Asian/Pacific Islander, what will the

nurse identify as a leading cause of death for people from this culture?

a. Malignant neoplasms

b. Influenza and pneumonia

c. Alzheimer’s disease

d. Chronic lower respiratory diseases

17. Why does poor health continue to occur among immigrant Asian populations?

a. Poor working environments and crowded living conditions

b. Refusal of Western medicine to treat Asian immigrants

c. Inability to tolerate Western medications

d. Low number of health care workers of Asian origin

18. How would a patient from the Black culture treat poison ivy?

a. Sprinkling crushed bluestone powder on the affected area

b. Placing a mixture of garlic, onions, and parsley on the site

c. Placing clay in a dark leaf over the affected area

d. Rubbing Vicks Vaporub on the area

19. In the Black culture, what would be used to treat colds?

a. Sassafras tea

b. Hot lemon water with honey

c. Hot toddy made of tea, honey, lemon, peppermint, and alcohol

d. All of the above.

20. Why are folk remedies still used today in the Black community?

a. Tradition of quality care and treatment by healers

b. Acknowledgement of the African heritage

c. Rituals associated with folk remedies

d. Close proximity of hospitals in the community

21. What would be a benefit of following the African food tradition of geophagy?

a. Dirt is high in calcium

b. Pica is an accepted cultural practice

c. Red clay is rich in iron

d. Starch is sweet and dry

22. For which reasons might a patient of the Black culture and of the Muslin religion refuse insulin

to treat diabetes mellitus?

a. Because any injectable medication is forbidden

b. If it has a pork base

c. Because it implies the person has not led a holy life

d. During Ramadan

23. Which is a health statistic of significance to Black or African Americans when compared to all


a. A lower incidence of breast cancer

b. Lower percentages of low birth weight infants

c. A lower crude birth rate

d. Lower male death rates from homicide

24. Who does the nurse recognize as being the leading authority figure within the Black familial


a. Female

b. Minister

c. Male

d. Oldest adult child

25. Why would some patients of the Black culture resent using health clinics for care?

a. Prescription medications are given out only to those seen first.

b. Cheaper accessible health care is regarded as demeaning.

c. A day’s work may be lost in waiting to be seen by a physician.

d. There are not enough clinics to focus on Black health problems.

Multiple Choice Questions

1. A patient from the Mexican heritage relates using a curandero for health care needs. What are the characteristics of this type of healer?

a. Considered to be a religious figure

b. Was born as a healer

c. Taught the ways of healing through herbs

d. All of the above.

2. In the Mexican health care system, what is the scope of practice of the partera?

a. The care given is confined to the pregnant woman

b. Only provides physical care

c. Acts alone without doing other consultations or referrals

d. Does not participate in labor and delivery

3. During a medical history with a patient from Puerto Rico, what preparations will the nurse need to include?

a. Those obtained from a botanica

b. Those obtained from a botanical center

c. Those obtained from a healer

d. Those obtained from a pharmacy

4. Which is a dilemma encountered by health care providers when trying to accommodate a patient of the Mexican culture’s desire to maintain hot and cold food preferences?

a. Avoiding all foods that contain certain spices

b. Understanding which foods the patient considers hot and cold

c. Obtaining the unusual foods native to a Mexican patient’s diet

d. Ensuring that all medications are taken with specific foods

5. Where might a patient of Puerto Rican heritage seek help when experiencing signs of a mental illness?

a. Milagros

b. Curanderismo

c. Santeria

d. Partera

6. What is a significant factor when caring for health problems of patients within the Hispanic culture?

a. Lack of Spanish-speaking health care providers impeding appropriate care delivery

b. Failure to highlight common chronic diseases among Hispanics in local media

c. Overall population is young with a high birthrate compared to the general population

d. Use of folk remedies creating cultural dissonance with the medical establishment

7. What would the combination of a young population, high birthrates, and lower socioeconomic status contribute to in the Hispanic population?

a. Higher incidence of births to women under age 18

b. Lower birth weight infants

c. Higher percentage of first trimester prenatal care

d. Higher infant mortality rate

8. Which health problem does the nurse identify as being a higher risk for the patient from the Hispanic culture when compared to the general population?

a. Septicemia

b. Unintentional injuries

c. Chronic lower respiratory diseases

d. Alzheimer’s disease

9. What would the nurse infer about the incidence of lung cancer being lower among Hispanic women versus that of the general population?

a. Hispanic women are not genetically predisposed to lung cancer.

b. Hispanic women are healthier than the general population.

c. Hispanic women have better preventive health practices.

d. Hispanic women are less likely to smoke.

10. What might a patient of German descent used to treat a stomachache?

a. Drink peppermint tea

b. Stop eating for at least 24 hours

c. Take black draught

d. Eat chicken soup

11. Which actions might a patient of German descent use to treat a cough?

a. Rub goose fat on the chest

b. Eating honey and milk

c. Drinking rum

d. All of the above.

12. When caring for a postoperative wound at home, what would a patient of German descent tend

to use?

a. Kerosene

b. Iodine

c. Salves and liniments

d. Onion compresses

13. For what would a patient of German descent use cloves?

a. Headache

b. Rheumatism

c. Toothache

d. Fever

14. What would a patient of Italian descent tell the nurse is the cause of pneumonia?

a. Moving air in the form of drafts

b. Eating food that was not nutritious

c. Improper balance of fluids

d. Not dressing properly

15. What will the nurse assess as an important component of healing for a patient of Italian


a. Religious faith in God

b. Use of garlic and olive oil in tonics

c. Wearing black when a family member is ill

d. Eating pasta at every meal

16. What will a patient of Polish descent tell the nurse is used to treat a cough?

a. Taking garlic oil

b. Goose grease rubbed on the throat

c. Drinking hot lemonade with whiskey

d. A mustard plaster on the chest

17. What will a patient of Polish descent use to treat a burn?

a. Aloe vera

b. Salt pork

c. Carbolic salve

d. Turpentine and liniment

18. For what would a patient of Polish descent tell the nurse that paregoric is used?

a. Gas

b. Diarrhea

c. Indigestion

d. Cramps

19. In which ways does the current United States health care system create barriers to individuals

from different cultures?

a. Expectation to select a physician from a list

b. Cost of treatments and tests

c. Violation of cultural beliefs and practices

d. All of the above.

20. How would the use of patient advocates bridge the gap of inadequate numbers of health care

providers representing culturally diverse population groups?

a. Speak to patients in their native language

b. Coordinate services to meet the patients’ needs

c. Resolve problems

d. All of the above.

21. The health care administrator is identifying ways to improve communication with non-English-

speaking patients. Which languages would the administrator target as being spoken by hospital


a. Russian

b. Chinese

c. Spanish

d. None of the above.

22. The nurse is experiencing collisions when attempting to improve cultural competency. What

types of collisions is this nurse experiencing?

a. Meeting dense cultural barriers

b. Sabotaged efforts

c. Unexpected hills

d. a and b only

23. Two nurses are overhead talking about their experiences with cultural competency. Which

experience would be considered an unexpected positive event?

a. Deep love of life and people

b. Role of a healer within a culture

c. Learning a foreign language

d. Being an advocate for funding

24. What self-observation does the nurse make that indicates that the nurse is “on the road” to

cultural competency?

a. Socialized by society

b. Individual culture and religion

c. Adhering to ways to protect health that are consistent with the dominant culture

d. Avoiding the use of amulets

25. What action would a nurse take to learn more about the different cultures represented in the


a. Walk through the community

b. Prepare a guide sheet with a list of herbs

c. Recognize hot–cold imbalances

d. Recognize folk diseases


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