Chapter 02: Cultural Competency

Question 1

Which of the following describes a physical, not a cultural, differentiator? a. Ritual b. Rite c. Race d. Norm e. Ethos

Answer 1

ANS: C Race is a physical, not a cultural, differentiator. REF: p. 21

Question 2

Which statement is true regarding the relationship of physical characteristics and culture? a. Physical characteristics should be used to identify members of cultural groups. b. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. c. To be a member of a specific culture, an individual must have certain identifiable physical characteristics. d. Gender and race are the two essential physical characteristics used to identify cultural groups. e. Whereas all cultural traits can be viewed as static, physical traits are dynamic.

Answer 2

ANS: B Physical characteristics do not symbolize cultural groups; there is a difference between the two, and they are considered separately. Cultures are dynamic in their evolution. REF: p. 21

Question 3

A fixed image of any group that rejects its potential for originality or individuality is known as a(n) a. acculturation. b. norm. c. stereotype. d. ethnos. e. custom.

Answer 3

ANS: C This definition describes a stereotype. A norm, on the other hand, is a standard of allowable behavior within a group, ethnos implies the same race or nationality, and acculturation is a process of adopting another culture’s behaviors. A custom refers to a habitual activity of a group in a given situation. REF: p. 21

Question 4

Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L’s son tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? a. “With your father’s permission, we will examine the stone and request that it be returned to him.” b. “The stone must be sent to the lab for examination and therefore cannot be kept.” c. “We cannot let him keep his stone because it violates our infection control policy.” d. “We don’t know yet if your father has another kidney stone, so we must analyze this one.” e. “I have found it unwise to make these kinds of individual exceptions to hospital procedure.”

Answer 4

ANS: A Health care providers should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient’s cultural background. It is better to mediate than to be coercive. The statement, “With your father’s permission, we will examine the stone and request that it be returned to him” does this most effectively. REF: p. 22

Question 5

To develop cultural competence, one should a. ignore one’s own cultural beliefs. b. attempt to convince the patient to accept institutional mores. c. realize that cultural values are difficult to change and must be respected. d. realize that all members of a cultural group behave the same way. e. understand that an individual’s culture has no effect on the delivery of health care in this country.

Answer 5

ANS: C To develop cultural competence, health care providers should examine their own beliefs, respect the unfamiliar, appreciate that cultural values are difficult to change, and do not expect all members of a cultural group to behave exactly the same. Differences in culture can sometimes have an overpowering effect on the delivery of health and medical care. REF: p. 22

Question 6

Your new patient is a 40-year-old Middle Eastern man with a complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to a. do the examination because it is a necessary part of the physical examination. b. ask a colleague from the same geographic area if this examination is acceptable. c. inform the patient of the reason for the examination and ask if it is acceptable to him. d. refer the patient to a provider more knowledgeable about cultural differences. e. forego the examination for fear of violating cultural norms.

Answer 6

ANS: C Asking, if you are not sure, is far better than making a damaging mistake. REF: p. 22

Question 7

Which statement is true regarding impoverished people? a. In the United States, socioeconomic status does not influence the delivery of health care. b. The morbidity and mortality rates of impoverished people are greater than those of the middle class. c. The morbidity and mortality rates of impoverished people are less than those of the middle class. d. No reliable statistics exist regarding the relationship of poverty to morbidity and mortality. e. The morbidity and mortality rates of impoverished people are similar to those of the middle class.

Answer 7

ANS: B Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity. REF: p. 23

Question 8

In terms of cultural communication differences, Americans are more likely to _____ than other groups of patients. a. emphasize attitudes and feelings b. maintain eye contact c. come quickly to the point d. use silence comfortably e. speak more softly than other cultures

Answer 8

ANS: C In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard. REF: p. 26

Question 9

Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? a. “How often do you have a medical examinations?” b. “What are your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” e. “Do you take herbal remedies?”

Answer 9

ANS: D This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. REF: p. 24

Question 10

A person’s definition of illness is likely to be most influenced by: a. race. b. ritual. c. enculturation. d. age group. e. socioeconomic class.

Answer 10

ANS: C The definition of “ill” is determined in large part by the individual’s —the process whereby an individual assumes the traits and behaviors of a given culture. REF: p. 24

Question 11

Informing a patient that he or she has a terminal illness is most likely to be discouraged in which cultural group? a. Navajo Native Americans b. Dominant Americans c. First-generation African descendants d. First-generation European descendants e. Hispanics

Answer 11

ANS: A The Navajo culture believes that thought and language have the power to shape reality; the desire to avoid discussing negative information is particularly strong in this culture. REF: p. 26

Question 12

A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask? a. “Why are you so depressed?” b. “It’s hard for me to gather useful information because your answers are so short.” c. “Are you uncomfortable talking with me?” d. “Does your religion make it hard for you to answer my questions?” e. “We will be able to communicate better if you will look at me.”

Answer 12

ANS: C It is all right to ask if the patient is uncomfortable with any aspect of your person and to talk about it; the other choices are less respectful. REF: p. 27

Question 13

As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to a. tell him that you understand his need to be alone. b. ask whether he has any questions. c. ask whether he would prefer to speak to the clinician. d. tell him that it is all right to be angry. e. stop questioning the patient immediately.

Answer 13

ANS: B The English worry about being overheard and tend to speak in modulated voices, so when they lean in toward you, they are probably ready with a question. REF: p. 26

Question 14

An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine’s attempt to a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. use herbal remedies and rituals. e. promote balance in an individual’s life.

Answer 14

ANS: B A more scientific approach to health care problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more “holistic” approach. REF: p. 27

Question 15

In a naturalistic or holistic approach to health, an example of a “hot” condition would be a. teething. b. joint pain. c. diarrhea. d. a nasal cold. e. a headache.

Answer 15

ANS: C A hot condition among cultures with a holistic approach is diarrhea. REF: p. 27

Question 16

An example of a “cold” condition would be a. a fever. b. a rash. c. tuberculosis. d. an ulcer. e. a sore throat.

Answer 16

ANS: C A cold condition among cultures with a holistic approach is tuberculosis. REF: p. 27

Question 17

An example of a cold food is a. chocolate. b. hard liquor. c. oil. d. onions. e. a dairy product.

Answer 17

ANS: E Dairy products are an example of a cold food; the others are hot. REF: p. 27

Question 18

A naturalistic or holistic approach to health care often assumes a. that hot conditions require treatment with a hot remedy. b. a reductionist view that looks to a very narrow cause and effect. c. there are external factors that must be kept in balance. d. that there are hot and cold conditions but not hot and cold remedies. e. that hot and cold conditions are the same among different cultures.

Answer 18

ANS: C A naturalistic or holistic approach often assumes that there are external factors—some good, some bad—that must be kept in balance if we are to remain well. REF: p. 27

Question 19

Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group? a. Native Americans b. Hispanics c. Chinese d. Italians e. Orthodox Jews

Answer 19

ANS: C Of all the choices, the Chinese are more likely to use MSG and soy sauce in their diet. REF: p. 28

Question 20

Which maternal factor is most predictive of whether an infant will receive inoculations? a. The mother has family support. b. The mother is divorced. c. The mother breastfeeds. d. The mother uses drugs. e. The mother received prenatal care.

Answer 20

ANS: E Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well. REF: p. 28

Question 21

Adolescents most likely to smoke, abuse substances, perform poorly in school, and be depressed are those who are a. from dual-income families. b. from families that emphasize strong religious beliefs. c. from deprived socioeconomic groups. d. unsupervised after school. e. involved in athletics after school.

Answer 21

ANS: D Adolescents who are unsupervised after school are more likely to smoke, abuse substances, perform poorly in school, and be depressed than adolescents in any other situation. REF: p. 28

Question 22

Knowledge of the culture(s) of the patient should be used to a. form a standard practice procedure for that culture. b. draw conclusions regarding individual patient needs. c. form stereotypical categories. d. help make the interview questions more pertinent. e. form a sense of the patient based on prior knowledge.

Answer 22

ANS: D The purpose of understanding the patient’s culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. REF: p. 28

Question 23

The attitudes of the health care professional are largely a. acculturated and cannot be changed. b. uninfluenced by patient behavior. c. difficult for the patient to sense. d. culturally derived. e. irrelevant to the success of relationships with the patient.

Answer 23

ANS: D The attitude of a health care provider is foundationally derived from his or her own culture but cannot cause stereotypical judgments to be made; understanding this is relevant to the success of patient relationships. Attitudes of the health care professional are easily detected by others, and they influence patient behavior. REF: p. 21

Question 24

Being sensitive to cultural differences that may exist between you and the patient is most useful in the avoidance of a. prejudice. b. stereotypic judgment. c. miscommunication. d. opinion formation. e. preaching to the patient.

Answer 24

ANS: C When you determine that cultural differences may exist, you must first use culturally sensitive communication modes to grasp what the patient means correctly or else prejudice, stereotypic judgment, tendency to preach, and you forming an opinion may inadvertently be perceived by the patient. REF: p. 26