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Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th
Edition

MULTIPLE CHOICE

1. When planning health care, the nurse should be mindful that members of the Asian culture
tend to:
a. miss appointments because they are present oriented and time is viewed as
flexible.
b. look to their ancestors for guidance.
c. plan ahead and be future oriented.
d. arrive early because they have no concept of time.
ANS: A
In Asian culture, individuals tend to be present oriented and time is viewed as being more
flexible than in the Western culture; being on time for appointments is not seen as a priority.

DIF: Comprehension REF: p. 194

2. A nurse is admitting a Mexican-American child, and the mother comments that the child was
exposed to mal ojo. The nurse should expect to find which symptom associated with this
exposure?
a. Fever
b. Nervous tension
c. Bruising
d. Somnolence
ANS: A
The child has what is referred to as mal ojo or “evil eye,” which can lead to diarrhea, fever,
and even death.

DIF: Comprehension REF: p. 198

3. A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,”
which is known as:
a. susto.
b. empacho.
c. bilis.
d. mal ojo.
ANS: A
Susto is an emotion-based illness common among Mexicans. An unexpected fall, a barking
dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature,
and vomiting.

DIF: Comprehension REF: p. 198

4. A priority action for the nurse who works with culturally diverse clients is completion of a:
a. sign language course.
 b. cultural self-assessment.
c. cultural client assessment.
d. continuing education course on how to speak Spanish.
ANS: B
The first step to becoming a culturally sensitive and competent health care provider is to
conduct a cultural self-assessment. Through identification of health-related attitudes, values,
beliefs, and practices, the nurse can better understand the cultural aspects of health care from
the client’s perspective.

DIF: Application REF: p. 191

5. A nurse is caring for a recent Asian immigrant client and is overheard making the following
comment, “These rituals you believe in are false. You live in America now and must believe
in realistic health practices, like Americans do.” The nurse is exhibiting:
a. stereotyping.
b. ethnocentrism.
c. cultural accommodation.
d. empathy.
ANS: B
Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best.

DIF: Comprehension REF: p. 180

6. The nurse is preparing a plan of care for an black patient who has had a change of bowel
habits from being constipated and having only two firm stools weekly to having three or more
loose stools daily. Which comment is related to cultural variation for health information?
a. The individual states, “I will need to discuss health care options with my
grandmother.”
b. The eldest male member of the family will make all health care decisions.
c. The patient has high respect for the nurse and nods approvingly, although she has
no intention of complying with instructions or plan of care.
d. The individual speaks very quietly and gently reaches to hold the nurse’s hand for
support.
ANS: A
In the African-American culture, women, especially “Granny,” play a key role in health care
decisions.

DIF: Application REF: p. 189 |p. 191, Table 10-1

7. A nurse is submitting a grant application to improve access to health care and mortality for
minority groups. The grant focuses on the six causes of death that are identified as priorities
for minorities, which include:
a. chronic obstructive pulmonary disease.
b. malnutrition.
c. cirrhosis of the liver.
d. cancer.
ANS: D
 Cancer is identified as a leading cause of excessive death among minority group members.
The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency,
diabetes, homicides/accidents, and infant mortality.

DIF: Comprehension REF: p. 182

8. A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows
very little about the health beliefs of this ethnic group. To research this group, she can use an
Internet search engine and enter the term “Russian cultures” or “Russian health beliefs.” To
obtain more generalized information, she could also search under:
a. federally recognized minorities.
b. marginalized populations.
c. Asian/Pacific Islander cultures.
d. Latino cultures.
ANS: B
Marginalized populations include recently arrived immigrants. Their lives and health care
needs are often kept secret and are understood only by them.

DIF: Comprehension REF: p. 182

9. Which statement is true regarding health care for minorities?

a. Federal legislation that provides free health insurance for minorities has resulted in
fewer minorities than members of the general population who lack health
insurance.
b. Higher costs of health care coupled with lower wages for minorities have
prevented most minorities from seeking health care.
c. Because many Mexican Americans are highly skilled workers with comparable
wages, they have the lowest uninsured rate.
d. Asians, because of their quiet demeanor and unwillingness to challenge the health
care system, have the highest rate of uninsured people.
ANS: B
Most families with racially or ethnically diverse backgrounds have a lower socioeconomic
status than is observed in the population at large. Dramatic changes in technology and
specialization in the health care field have caused health care costs to skyrocket. Therefore,
not everyone can afford health care services.

DIF: Comprehension REF: p. 182

10. While completing a nursing degree in Virginia, a student who is interested in teaching in
Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of
Mexican-Americans live there. This nursing student values:
a. cultural competence.
b. ethnocentrism.
c. prejudice.
d. stereotyping.
ANS: A
 Cultural competence is the responsibility of all nurses to become knowledgeable about the
values, beliefs, and health care practices of the culturally diverse groups that are dominant in
the nurse’s particular practice area.

DIF: Application REF: p. 188

11. A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The
nurse determines that the baby has had diarrhea and vomiting for several days, resulting in
dehydration. Physical examination reveals small, round burns on the abdomen. These burns
probably are the result of cigarettes or burning cotton used to:
a. try to quiet the child and is considered child abuse.
b. bring out toxic wind from the body.
c. balance heat loss from the body.
d. brush the body with ruda to allow spirits to return.
ANS: C
In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin,
usually the abdomen, is done to compensate for “heat” lost through diarrhea. This type of
burning is a common part of self-care.

DIF: Comprehension REF: pp. 196-197

12. A cultural phenomenon that is based on biologic variation would include:

a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip.
b. denser bones in blacks result in less morbidity associated with osteoporosis.
c. the grandmother who determines that her grandchild has scoliosis and should seek
treatment, then informs the parents of her decision.
d. a family that participates in feasts prepared to celebrate and make decisions.
ANS: B
Biologic variations include denser bones in blacks. Biologic variations such as body build and
structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional
variations exist among different cultures. Other common variations include skin color, eye
shape, hair texture, and adipose tissue deposits.

DIF: Analysis REF: p. 191

13. A nurse plans to move to an area that is rich in immigrants from several countries and is
concerned about respecting others’ cultural beliefs. The nurse’s first step to ensure cultural
competence and sensitivity is to:
a. enroll in a nursing theories course to increase knowledge about transcultural
practices.
b. become immersed in nursing literature about culturally diverse clients.
c. participate in continuing education that focuses on health assessment variations
among cultural groups.
d. conduct a cultural self-assessment.
ANS: D
A cultural self-assessment allows the nurse to identify attitudes about individuals from
different cultures.
 DIF: Application REF: p. 196

14. A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip.
The nurse reviews the client’s diet history while hospitalized and is concerned that the patient
refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the
nurse overlooking? Asian Americans:
a. have denser bones than other ethnic groups.
b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis.
c. would participate in the practice of burning to compensate for this injury.
d. would consult a curandero for dietary consultation.
ANS: B
Pork bones and shells are rich in calcium, reducing the risk of osteoporosis.

DIF: Comprehension REF: p. 197

15. A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group
attending a health fair. The nurse should be aware:
a. that Hispanic women overestimate the prevalence of cancer and strictly following
breast self-examination guidelines.
b. of the importance of risk factors such as smoking and alcohol consumption that
increase esophageal cancer when speaking with black.
c. that American-Indian women have a higher rate of ovarian cancer than the general
population.
d. that cancer as well as heart disease and stroke are lower in ethnic groups.
ANS: B
Black men have a higher risk for esophageal cancer than the general population so teaching
risk factors is needed.

DIF: Comprehension REF: p. 191

16. A nurse performing a history and physical on a newly admitted Hispanic patient learns the
patient has just used the services of a savador to:
a. determine which herbs would best reduce hot flashes in a menopausal woman.
b. communicate with a family member who recently died.
c. receive treatments to reduce lower back pain.
d. receive acupuncture to stop smoking.
ANS: C
Hispanic patients may want the support and care of a savador, which is similar to that offered
by a chiropractor.

DIF: Comprehension REF: p. 195

17. An Asian teenager is admitted with an eating disorder which she contributes to by not meeting
the academic expectations of her parents. The nurse is overheard saying, “That isn’t the
reason; all Asians are really smart.” This nurse is demonstrating:
a. cultural humility.
b. stereotyping.
c. cultural assimilation.
 d. acculturation.
ANS: B
Stereotyping is associating certain behavior or competencies with an ethnic group without
considering the individual.

DIF: Comprehension REF: p. 180

18. A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red
yarn around the wrist. The nurse compliments the child’s “jewelry,” knowing it is believed to
prevent:
a. mal ojo.
b. susto.
c. bilis.
d. empacho.
ANS: A
Mal ojo is due to “admiration” from a stranger resulting in diarrhea.

DIF: Application REF: p. 198

19. A Hispanic patient is visited by several family members and the nurse witnessed one visitor
who pinches a piece of skin at the waist. The nurse asks the purpose and learns the “provider”
is listening for a snap from the abdominal region, which is then repeated several times. The
patient most likely suffers from:
a. mal ojo.
b. susto.
c. bilis.
d. empacho.
ANS: D
Empacho is believed to be caused by lodged food particles, causing acute stomach/intestinal
pain.

DIF: Comprehension REF: p. 198

20. A nurse is seeking to become culturally competent in regard to obtaining information during
health history and when performing physical diagnosis. The nurse is aware that which
biologic variation is found in all of the following ethnicities: blacks, Asians, Hispanics, and
American Indians?
a. Mongolian spots
b. Sickle cell anemia
c. Lactose intolerance
d. Thalassemia
ANS: C
Lactose intolerance is found in all four of the noted ethnicities.

DIF: Application REF: p. 193, Table 10-2

MULTIPLE RESPONSE
 1. Six cultural phenomena that vary among cultural groups are known to affect health care. The
influence of the consequences of these phenomena can be seen in which of the following?
(select all that apply)
a. Asians and American Indians tend to be nonadherent with medications because
they believe that the environment has no control over their fate.
b. Some cancers such as stomach cancer occur less frequently among blacks.
c. Blacks and American Indians often resist direct eye contact.
d. Mexican Americans are more likely to stand close and touch health care providers.
e. Whites are often late for health care appointments.
ANS: C, D
The use of eye contact is a cultural communication phenomenon. Cultures such as black and
American Indian may view direct eye contact as rude behavior. Space and touch are cultural
phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand,
Mexican Americans tend to be comfortable with less space because they like to touch persons
with whom they are talking.

DIF: Analysis REF: pp. 191-192

2. A nurse involved in researching the leading causes of death for minorities considers the
federally defined minority groups, which include: (select all that apply)
a. Blacks
b. Russians
c. Hispanics
d. Asians or Pacific Islanders
e. Scandinavians
ANS: A, C, D
The Federally defined minority groups include blacks, Hispanics, American Indians, and
Asians or Pacific Islanders.

DIF: Comprehension REF: pp. 181-182

COMPLETION

1. On the scale from 1 to 10, with 1 being no prejudice and 10 being extreme prejudice, the
placement of hate on the continuum would be at number _____.

ANS:
10

Hate is the extreme negative manifestation of prejudice, followed by contempt, then tolerance,
which is more neutral.

DIF: Application REF: p. 183, Figure 10-1

2. Although communication varies among members of different cultures, the greatest obstacle to
providing multicultural care is differences in _____.

ANS:
language
Language can be the greatest obstacle to providing multicultural care. If the client does not
speak the same language as the nurse, a skilled interpreter is mandatory.

DIF: Comprehension REF: p. 191

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