Chapter 09: Cultural Diversity in Health Care Nursing School Test Banks

Chapter 09: Cultural Diversity in Health Care
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. According to Leininger, cultural imposition is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be:
a. Abortion.
b. Wound management.
c. Blood transfusion.
d. Advance directives.
ANS: B
Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

2. Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a:
a. Task force formed to commemorate a New Years celebration in the Western tradition.
b. Project to provide Christmas gifts to the children in a daycare program.
c. Celebration of National Nurses Week with the focus on cultural care.
d. Task force to develop a poster for the unit depicting religions of the world.
ANS: C
Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses Week, with a focus on nursing interests, reflects the culture of nursing.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

3. One of the staff nurses on your unit makes the comment, All this time I thought Mary was black. She says she is Jamaican. The best response would be to say:
a. Who cares what she is?
b. What did you think when you learned she was Jamaican?
c. Why did you assume she was black?
d. We have never had a Jamaican on this unit.
ANS: B
The response of the nurse manager invites cultural awareness, which involves self-examination and in-depth exploration of ones own biases, prejudices, and assumptions.

REF: Page 156 TOP: AONE competency: Communication and Relationship-Building

4. As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, Why is it that when John and I work together in giving patients care, he jokes about my being a little fat Mexican? The nurse managers best response is, Do you think he:
a. Is sensitive to your culture?
b. Wants to learn more about you?
c. Has been hurt and wants to hurt others?
d. Is stereotyping you without thinking?
ANS: D
Prejudices enable us to make sense of the situations in which we find ourselves, yet they also constrain understanding and limit the capacity to come to new or different ways of understanding. It is this contradiction that makes prejudice paradoxical. (Spence, 2004, p. 163). Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

5. The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patients eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to:
a. Acculturation.
b. Ethnocentricity.
c. Cultural diversity.
d. Cultural sensitivity.
ANS: D
Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

6. A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his acupuncture doctor for treatment of his migraine headache. The best response to this patient would be:
a. How long have you been using acupuncture treatment?
b. Do you think acupuncture relieves your pain satisfactorily?
c. What have you told your heart specialist about your migraines and treatment?
d. Have you tried nonprescription pain medication or been given a prescription drug for your headaches?
ANS: A
Acknowledging the patients use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patients cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurses experience of health care in Western cultures.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

7. Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff?
a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill.
b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia.
c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying.
d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.
ANS: C
The cultural and religious backgrounds of nurses influence their perceptions of dignity-conserving care. For example, foreign-born Catholic nurses stated the dying experience should not be altered by analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Approaches to working with differences in the diverse cultural and religious backgrounds of patients, families, and nurses alike include taking time to have conversational chats with patients in end-of-life and with colleagues that will facilitate learning about each other and provide care that fits with the patients cultural beliefs about dying.

REF: Page 159 | Page 160
TOP: AONE competency: Communication and Relationship-Building

8. Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following?
a. Behavior
b. Love for people
c. Shared vision
d. Genetic predisposition
ANS: A
Culture is determined by behaviors and beliefs and develops slowly.

REF: Pages 154-156
TOP: AONE competency: Communication and Relationship-Building

9. The nurse manager for a units culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It:
a. Develops over time.
b. Maintains a strong work ethic.
c. Changes easily.
d. Develops quickly.
ANS: A
Culture is a patterned behavioral response that evolves slowly as times change. The culture may or may not maintain a strong work ethic.

REF: Pages 154-156
TOP: AONE competency: Communication and Relationship-Building

10. In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to:
a. Diabetes.
b. Cardiovascular disease.
c. Cancer.
d. Asthma.
ANS: A
Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics.

REF: Page 157 TOP: AONE competency: Knowledge of the Health Care Environment

11. Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of:
a. Dominant versus nondominant behaviors.
b. The need to recognize diversity within groups.
c. The impact of cross-culturalism.
d. How language separates subgroups.
ANS: B
When working with various cultural groups and diversity, it is important to recognize that diversity also exists within groups. Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable.

REF: Page 161 TOP: AONE competency: Communication and Relationship-Building

12. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidates lack of eye contact reflects the candidates:
a. Lack of confidence.
b. Professional behavior.
c. Cultural sensitivity.
d. Ethnicity.
ANS: D
Ethnicity refers to groups of people who are classified according to common racial, tribal, religious, linguistic, or cultural backgrounds.

REF: Page 154 TOP: AONE competency: Communication and Relationship-Building

13. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidates lack of eye contact reflects the candidates cultural sensitivity. You are exhibiting:
a. Acculturation.
b. Cultural sensitivity.
c. Ethnocentrism.
d. Transculturalism.
ANS: B
Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the candidates background in relation to eye contact demonstrates cultural sensitivity.

REF: Page 154 TOP: AONE competency: Communication and Relationship-Building

14. Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her book learning is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating:
a. Cultural awareness.
b. Cultural sensitivity.
c. Acculturation.
d. Cultural marginality.
ANS: C
In accepting the practices of the dominant group on the unit, Mary is demonstrating acculturation.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

15. At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of:
a. Ethnicity.
b. Work environment.
c. Work culture.
d. Marginalization.
ANS: C
Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty.

REF: Pages 154-156
TOP: AONE competency: Knowledge of the Health Care Environment

16. As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit?
a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships.
b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States.
c. Stress to these new staff that your unit is a family and that staff members take pride in saying that they are from Unit 4.
d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.
ANS: A
Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals now define themselves as members of the dominant culture and is evidenced by when individuals say they are from where they live and practice. When individuals grow up within a culture and take on the characteristics of that culture, it is referred to as socialization. Assisting the staff to recognize differences in the relationships between physicians and nurses on the unit and those in their country of origin is assisting adaptation or acculturation and is promoting positive patient outcomes.

REF: Page 154 | Page 161
TOP: AONE competency: Communication and Relationship-Building

17. During managers meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say:
a. I wonder if we should consider changing our policy on performance appraisals? What do you think?
b. Sean, your approach to appraisal is completely off track and does not reflect available evidence.
c. The system that has been developed needs to be implemented. We have already spent enough time in discussion.
d. Forget about change in this policy. It is fine as it is.
ANS: A
Males and females in the workplace are likely to have different management styles, and although not all males are authoritative or females more participatory, women are likely to use more participatory and inclusive methods.

REF: Page 161 | Page 162
TOP: AONE competency: Communication and Relationship-Building

18. As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle?
a. Transculturalism
b. Cross-culturalism
c. Multiculturalism
d. Acculturation
ANS: C
Multiculturalism refers to maintaining several different cultures, such as the uniqueness of different work units. Cross-culturalism means mediating between/among cultures, and transculturalism denotes bridging significant differences in cultural practices.

REF: Page 161 TOP: AONE competency: Communication and Relationship-Building

19. During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xias culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of:
a. Bias.
b. Cultural awareness.
c. Cultural diversity.
d. Ethnocentricity.
ANS: B
Cultural awareness involves self-examination and in-depth exploration of ones own cultural and professional background, including biases, prejudices, and assumptions, including assumptions about thinking modes and decision making.

REF: Page 156 TOP: AONE competency: Communication and Relationship-Building

20. Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects:
a. Stereotyping.
b. Cultural diversity.
c. Ethnocentricity.
d. Transcultural care.
ANS: D
Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status.

REF: Page 160 TOP: AONE competency: Communication and Relationship-Building

21. Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include:
a. Eye contact.
b. Personal space.
c. Harassment.
d. Expressions of feeling.
ANS: B
Body movements, eye contact, gestures, verbal tone, and physical closeness when communicating are all part of a persons culture. For the nurse manager, understanding these cultural behaviors is critical in accomplishing effective communication within the diverse workforce population.

REF: Page 160 | Page 161
TOP: AONE competency: Communication and Relationship-Building

22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as:
a. Having cultural sensitivity.
b. Experiencing cultural diversity.
c. Experiencing cultural marginality.
d. Experiencing acculturation.
ANS: C
The new graduate is caught between two cultures at this pointwork and educationand expresses feelings of belonging to neither.

REF: Page 155 | Page 156
TOP: AONE competency: Communication and Relationship-Building

23. In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects:
a. Lack of understanding of the seriousness of the patients illness.
b. Lack of communication between family members.
c. The social organization of friendships and family networks in East Indian culture.
d. Lack of caring about the hospital environment by the friends and family.
ANS: C
The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision of care for patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures.

REF: Page 156 TOP: AONE competency: Knowledge of the Health Care Environment

24. Sarah, one of your RNs, tells you that she cant understand why Jim, an Aboriginal patient, wants to do a smudge. Sarahs response is based on her:
a. Cultural marginality.
b. Circle of familiarity.
c. Cultural understanding.
d. Acculturation.
ANS: B
The circle of familiarity refers to constrained interpretation based on ones values, attitudes, and beliefs.

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

25. Sarah, one of your RNs, tells you that she cant understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following?
a. Explain to Jim that there is no smoking in the hospital.
b. Inform Jim that fires are not allowed in the hospital.
c. Insist that he give you his tobacco because it is unhealthy for him.
d. Ask him what he means by a smudge and what meaning it has for him.
ANS: D
By talking with Jim, Sarah is able to step outside her circle of familiarity and find and enhance her understanding of personally held prejudices. Prejudice enables Sarah to find meaning in situations, but it also limits understanding. Paradox describes this tension. We have the responsibility to acknowledge the possibility of tension as a potential for new and different understandings derived from our communication and interpretation. Possibility, therefore, presumes a condition for openness with a person from another culture (Spence, 2004).

REF: Page 155 TOP: AONE competency: Communication and Relationship-Building

MULTIPLE RESPONSE

1. As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)?
a. Stereotyping of others
b. Respecting others
c. Understanding the importance of language
d. Encouragement of potential in all staff
e. Age bias
f. Disrespect for others
ANS: B, C, D
Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences.

REF: Page 160 | Page 161
TOP: AONE competency: Communication and Relationship-Building

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