TEXTBOOK  Cultural
Diversity in Health and Illness
  8th Edition, 2013
ISBN-13: 9780132840064
AUTHOR  Rachel
E. Spector
Multiple Choice
1. The nurse desires
to become more culturally competent when providing care to patients from
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
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
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
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
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
assess in this
a. Americanization of the patient’s name
b. Engaging in activities with members of the family’s preferred social
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
reduce generational
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
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
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
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
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
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
c. Ensuring that all Americans have health insurance
d. Eliminating childhood diseases
24. Within the
Healthy People 2020 document, what characteristics contribute to health
in the United
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
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
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
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
b. Restriction of public immunizations and medications for communicable
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
c. Exploding health care costs and the challenges to reform and control
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
1. The nurse is observing a healing ceremony performed
by people of the American Indian culture. What is a characteristic of this
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
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
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
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
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
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
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
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
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
7. What would the combination of a young population,
high birthrates, and lower socioeconomic status contribute to in the Hispanic
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
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
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
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 TEXTBOOK ONLY …. … DON’T WASTE MY AND YOURS TIME WITHOUT USING TEXTBOOK..ONLY AND ONLY TEXTBOOK …..  THANKShca_340_multiple_choice_questions.docx

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