Chapter 4: Sociocultural Issues(FREE) Nursing School Test Banks

Chapter 4: Sociocultural Issues
Test Bank

MULTIPLE CHOICE

1. An older Asian female with a diagnosis of depression is cared for by her granddaughter. Her granddaughter is very attentive to the clients needs, attends every therapy session, and is active in the planning and implementing of the treatment plan. The granddaughters valuing of her grandmother is most likely due to her:
a. Ethnicity
b. Cultural beliefs
c. Religion
d. Stereotype
ANS: B
Cultural beliefs develop over many generations and are a learned set of values, beliefs, and behaviors. Asian cultures commonly value their elderly family members. Ethnicity and religion do not explain the granddaughters behavior in that ethnicity describes customs and socialization patterns, and religion refers to an organized form of worship. Stereotyping is a preconceived belief about another cultural group, so it does not apply to this situation.

DIF: Cognitive Level: Application REF: p. 31 OBJ: 1
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. A traditional Arab female client is brought to the emergency room by her husband. She complains of feeling very anxious and short of breath and has chest pain. What would likely be a hindrance to the care of this client?
a. The emergency room physician is female.
b. Her husband asks if he can stay with his wife.
c. One of the emergency room nurses is of Arab descent.
d. The only caregivers available in the emergency room are male.
ANS: D
In some traditional Arab cultures, a woman will not make eye contact with any man except her husband and may not be touched by another man. Having only male staff in the emergency room on this shift would block necessary care. Arrangements would have to be made to have a female staff member come to the emergency room to assist in client care. The other options should not cause a problem.

DIF: Cognitive Level: Application REF: p. 32 OBJ: 3
TOP: Characteristics of Culture KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

3. Disease is defined as _____ dysfunction.
a. Social
b. Emotional
c. Physical
d. Intellectual
ANS: C
Disease differs from illness in that disease is an abnormal physical function, whereas illness refers to social, emotional, and intellectual dysfunction. Illness is affected by culture, but disease is not.

DIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity

4. The nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks English, but she is accompanied by her mother who does not. The client has a history of mental illness, and through the interpreter, the nurse learns that the mother, who has traditional Puerto Rican cultural beliefs, believes that the clients mental illness is caused by:
a. Witchcraft
b. Stress
c. Chemical imbalances
d. A trance
ANS: A
It is a common traditional Puerto Rican cultural belief that mental illness is caused by witchcraft, magic, or evil spells, as opposed to more traditional Western medicine, which believes that stress and chemical imbalances play a role in mental illness. A trance is considered a state of consciousness in some cultures.

DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. A client is continually late for his appointment at the mental health clinic. What is a likely reason for his lack of punctuality?
a. Need for environmental control
b. Time orientation
c. Space comfort zone
d. Territorial needs
ANS: B
Mental dysfunction can lead to incorrect perception of time, causing the client to be continually late. In addition, some cultures do not see schedules and specific appointment times as important, causing the client to be continually late in the eyes of the caregiver. Environmental control refers to an individuals need to control his or her perception of the environment. Comfort zones are highly culture based, meaning that individual interpretation of personal space varies among cultures. Territorial needs provide a sense of identity and security for some clients.

DIF: Cognitive Level: Comprehension REF: p. 36 OBJ: 5
TOP: Space, Territory, and Time in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

6. Which client communication problem can the nurse most easily correct?
a. Age differences
b. Altered cognition
c. Cultural differences
d. Gender differences
ANS: C
The nurse can easily correct communication problems caused by cultural differences in a number of ways, including learning what cultural beliefs and practices are important to the client and being accepting of those beliefs. Communication problems due to age and gender differences and altered cognition cannot be corrected by the nurse.

DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5
TOP: Communication in Cultural Assessment
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

7. What is the social orientation among most middle-class American families?
a. Extended
b. Friends
c. Significant others
d. Nuclear
ANS: D
The nuclear family is the social orientation of family that is seen most frequently in this group. The extended family is seen as the social orientation for cultures such as some Alaskan, traditional Chinese, and Mexican cultures. Friends and significant others are not identified as a social orientation of family.

DIF: Cognitive Level: Knowledge REF: p. 36 OBJ: 5
TOP: Social Organization in Cultural Assessment
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

8. It is important for the nurse to be familiar with the religious practices of clients cared for most often in a particular region because attitudes toward health and illness, death and burial, food, and procreation have a strong impact on a clients beliefs and practices. The nurse knows that the religion practiced most often around the world is:
a. Buddhism
b. Jehovahs Witness
c. Christianity
d. Ahmadiyya
ANS: C
More than 2 billion individuals throughout the world are practicing Christians. Although these religions are seen in large numbers worldwide, it is important for the nurse to be familiar with the religions most frequently seen in the client populations with whom he works within his own area.

DIF: Cognitive Level: Knowledge REF: p. 37 OBJ: 6
TOP: Social Organization in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

9. The metabolism of psychotropic medications is most likely to be affected by:
a. Ethnicity
b. Religion
c. Culture
d. Values
ANS: A
Ethnicity is a determining factor in a persons genetic makeup. Religious and cultural practices could play a role in the metabolism of medications as a result of food or alternative treatment interactions with medications, but the metabolism is more closely related to the genetic makeup. Values have little to do with the metabolism of medications.

DIF: Cognitive Level: Knowledge REF: p. 37 OBJ: 5
TOP: Biological Factors in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

10. A male Hmong client from Laos is a client at an outpatient mental health clinic who is being seen for his diagnosis of bipolar disorder. The importance of lithium testing was stressed in his discharge plans; however, it is discovered that he has had his lithium level checked only once, rather than the three scheduled times. What is the nurses best action?
a. Remind the client about the importance of lithium level testing.
b. Make scheduled appointments for the client to get his lithium level tested.
c. Give the client written information regarding the importance of lithium level testing and written instructions on how to make appointments for testing.
d. Talk with the client to see if there is a reason that he is not getting his lithium levels checked as outlined in his discharge plans.
ANS: D
In the Hmong culture, it is believed that loss of blood leads to decreased body strength, which can cause the soul to leave the body, resulting in death. If the nurse did not discuss why the client was not getting his blood levels tested and gave him additional instructions as listed in the other options, the nurse would not understand and would not be able to incorporate the clients cultural beliefs into the plan of care. The nurse and the client can now make revisions that will be acceptable while meeting the needs of the client.

DIF: Cognitive Level: Application REF: p. 37 OBJ: 5
TOP: Biological Factors in Cultural Assessment
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

11. Culture includes common beliefs and practices in areas such as religion, economics, diet, health, and:
a. Genetics
b. Occupations
c. Patterns of communication
d. Stereotypes
ANS: C
In addition to shared beliefs and practices in religion, economics, diet, and health, a persons cultural integration consists of patterns of communication, politics, art, and kinship. The other three options are not part of a persons culture.

DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 3
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. What is the usual approach to care for individuals who practice folk medicine?
a. Fragmented
b. Impersonal
c. Disjointed
d. Personalized
ANS: D
Folk medicine is highly personalized; the descriptors fragmented, impersonal, and disjointed more often are associated with the Western medicine approach to health care.

DIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

13. A Navajo Native American is traveling across the country and becomes ill. He visits a hospital emergency room and appears very uncomfortable in the surroundings. The nurse knows that traditional Navajo Native Americans typically receive health care in:
a. Homes
b. Small hospitals
c. Physicians offices
d. Outpatient clinics
ANS: A
Many traditional Native Americans receive health care in their homes, community settings, or social places. The emergency room setting would be very uncomfortable for this client.

DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. A client seen in the mental health clinic feels her depression is the result of being punished due to becoming pregnant as an adolescent and giving the infant up for adoption against her familys wishes. This view of her depression is considered:
a. Exaggerated
b. Naturalistic
c. Personalistic
d. Stress
ANS: C
Personalistic illnesses are seen as aggression or punishment directed toward a specific person. Naturalistic illnesses are caused by impersonal factors without regard for the individual. Forces that exist outside the individual cause mental illness.

DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. The nurse in the Emergency Department finds a woman collapsed on the floor and crying loudly. The womans husband was in a car accident and is being attended to by the medical staff. Which statement by the nurse best demonstrates acting in a culturally competent manner?
a. You need to control yourself. Your husband was not injured that badly.
b. Let me take you to a room with more privacy so we can talk.
c. I am concerned about how you are acting right now. No one else here is acting like this.
d. We will call the psychiatrist to see if medication can be ordered for you.
ANS: B
The nurse is demonstrating cultural competence and using cross-cultural therapeutic health care skills by offering to allow the client to express herself. The nurse is imposing personal beliefs on expected behavior in the other options.

DIF: Cognitive Level: Application REF: p. 35 OBJ: 2
TOP: Cultural Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. A 45-year-old married man comes to the community mental health center after he is suspended from his job for fighting. Upon talking to him, the nurse discovers he and his wife recently moved to the United States and his wife needs to work to pay bills. He is angry and embarrassed that he cannot be the sole provider for his family. His behavior may be the result of:
a. Cultural stereotyping
b. Gender role conflict
c. Religious beliefs
d. Territoriality conflicts
ANS: B
Traditional roles for men and women are in conflict with societal expectations of Western society in this situation. Men tend to demonstrate more violent and abusive behaviors as mental health problems with this conflict. Cultural stereotyping is imposed by someone outside the culture, and religious and territoriality conflicts do not apply to this circumstance.

DIF: Cognitive Level: Application REF: p. 36 OBJ: 4
TOP: Social Organization: Gender Roles KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. A nurse preparing to interview a client in the clients room begins to move newspapers off a chair to sit down. The client requests that the nurse sit in another chair and leave the newspapers where they were. The client is demonstrating:
a. Personal space
b. Paranoia
c. Manipulation
d. Territoriality
ANS: D
Territoriality is the need to gain control over an area of space and claim it for oneself, as it helps to provide a sense of identity, security, autonomy, and control over the environment. Personal space is the distance maintained between people. Manipulation and paranoia are not demonstrated in this case.

DIF: Cognitive Level: Application REF: p. 36 OBJ: 5
TOP: Space, Territory, and Time in Cultural Assessment
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

18. A male client is visiting his family in the United States and experiences what his family describes as a breakdown. His family takes him to a stress treatment center at a local mental health clinic. The client is a follower of traditional folk medicine practices and is agitated when he learns that he must see a licensed psychiatrist. Which care providers is this client most likely accustomed to? (Select all that apply.)
a. Healers
b. Shamans
c. Nurse practitioners
d. Spiritualists
e. Lay unlicensed therapists
ANS: A, B, D, E
Individuals who practice folk medicine for care typically do not see licensed health care providers, such as nurse practitioners and physicians. Folk medicine beliefs regarding the causes of disorders and treatments are different from Western medicine beliefs.

DIF: Cognitive Level: Knowledge REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

19. Which areas comprise the DSM-IV-TR cultural assessment tool for clients? (Select all that apply.)
a. Cultural identity of the client
b. Overall cultural assessment
c. Cultural explanation of the illness
d. Cultural factors relating to previous mental illness
e. Cultural factors relating to psychosocial environment
f. Cultural elements of relationship between client and care provider
g. Cultural factors related to level of functioning
ANS: A, B, C, E, F, G
The six categories of cultural identity of the client, cultural explanation of the illness, cultural factors relating to psychosocial environment, cultural factors relating to level of functioning, cultural elements of the relationship between client and care provider, and overall cultural assessment constitute the cultural assessment tool, which allows mental health care providers to learn how clients perceive their world and how they cope, according to their culture. Previous mental illness would be found in the history section of a clients assessment.

DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5
TOP: Cultural Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

20. Refugees frequently experience depression, anxiety, and stress-related disorders caused by their particular circumstances. Therefore, in addition to a cultural assessment, what is important for the nurse to assess? (Select all that apply.)
a. Immigration history
b. History of arrival in the new country
c. How long the refugee has been in the new country
d. Whether anyone or anything was lost in coming to the new country
e. What type of medical insurance the refugee will be seeking to obtain
ANS: A, B, C, D
A refugee is a person who flees from his or her home or country, usually because of war or persecution in the homeland. The refugee has experienced trauma not only in his life experiences, but also in the process of fleeing from home. Therefore, a more accurate assessment can be performed if these questions are answered. The type of medical insurance obtained is of little concern to this person at this time.

DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 7
TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. Cultural assessments allow the health care provider to understand the unique beliefs clients may have regarding mental illness and how they cope. Key areas to assess include: (Select all that apply.)
a. Communication
b. Space and territory
c. Biological orientation
d. Defense mechanisms
e. Social orientation
ANS: A, B, C, E
The six areas of cultural assessment on various tools include: communication, environmental control, space and territory, time, social orientation, and biological factors. Defense mechanisms do not pertain to cultural assessments.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 5
TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

22. A __________ is a simplified or standardized belief or conception regarding people who belong to another culture.

ANS:
stereotype, stereotyping
stereotyping, stereotype
Stereotyping can be negative or positive but can cause a mental health client to resist care if he feels he is being stereotyped by his caregiver. Extreme stereotyping is referred to as prejudice.

DIF: Cognitive Level: Knowledge REF: p. 31 OBJ: 2
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

23. __________ is a term that divides people into groups based on biological characteristics, including skin color, features, hair texture, and self-identification.

ANS:
Race
Race differs from ethnicity in that ethnicity refers to similar characteristics but is better defined socially.

DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 1
TOP: Nature of Culture KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

24. When a person believes that there is a power greater or higher than any human being, he is referring to his __________.

ANS:
spirituality
This is an important concept for many individuals in terms of the progression of their illness and the plan of care.

DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 1
TOP: Nature of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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