C 21

Chapter 21: Cultural and Spiritual Awareness
MULTIPLE CHOICE
1. What action by the nurse would indicate cultural competence?
a. Displays no favoritism
b. Tries to treat all patients the same
c. Prioritizes care based on cultural needs
d. Wants to learn more about other ethnic groups
ANS: D
One model of cultural competence has five aspects. They include cultural awareness, cultural
knowledge, cultural skill, cultural encounter, and cultural desire. Cultural knowledge is
seeking and obtaining information regarding different cultural and ethnic groups. The other
options are applicable to quality nursing care.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 489
OBJ: Define cultural competence.
TOP: Cultural competence
MSC: NCLEX: Psychosocial integrity
2. What is an example of a system barrier to cultural competence?
a. No kosher diet options on menu
b. No sinks in every patient room
c. No privacy curtains in exam rooms
d. A strict and enforced policy against more than one visitor in the ICU
ANS: D
System barriers are due to the agencys structure and policies that do not support cultural
diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with
a strong emphasis on the extended family. Provider barriers are those such as a nurse may
have, including lack of information about a culture. Including kosher diet options on the menu
and making changes to room environments (including privacy curtains and sinks in every
room) are provider barriers that can be addressed.
PTS:
OBJ:
TOP:
MSC:
1
DIF: Cognitive Level: Analysis
List practice issues related to cultural competence.
System barriers to cultural competence
NCLEX: Psychosocial integrity
REF: p. 491
3. Which of the following actions cause health care disparities?

a. Refusal of treatment
c. Trust in the health care system
b. Providerpatient relationships
d. Provider bias and discrimination
ANS: A
Disparities in health care can include both provider and patient variables. Patient variables are
mistrust of the health care system and refusal of treatment.
PTS: 1
DIF: Cognitive Level: Synthesis
REF: p. 491
OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.
TOP: Health care disparities
4. Which of the following actions would have little to no impact in helping resolve health care
disparities?
Research on life stressors
Access to basic health care
Increasing diversity of health care workers
Health promotion and wellness programs
a.
b.
c.
d.
ANS: A
Some solutions to help resolve health care disparities include the following: increasing the
diversity of health care providers; ensuring that all people have access to affordable, basic
health care; promoting wellness and a healthy lifestyle; strengthening providerpatient
relationships; increasing cultural competency of health care providers; and conducting
research to determine why certain diseases affect minorities so greatly and to discover
effective intervention strategies. Research on life stressors does not have an impact on
resolving health care disparities.
PTS: 1
REF: p. 491
TOP: Resolving health care disparities
5. Based on assessment data, the nursing diagnosis for a patient is spiritual distress related to
loneliness or social alienation. What would be included in spiritual nursing interventions?

c. Assist with activities of daily living.
d. Evaluate ability to understand events.
a. Participate in active listening.

b. Identify level of functioning.
ANS: A
Active listening is an example of a spiritual nursing intervention. Other interventions include

the following: prayer, presence, scripture reading, peaceful environment, meditation, music,
pastoral care, inspiring hope, validation of the patients thoughts and feelings, values
clarification, sensitive responses to patient beliefs, and developing a trusting relationship.
Identifying level of functioning and ADLs address basic human needs. Evaluating the ability
to understand events is addressing cognitive function.
PTS: 1
REF: p. 493
TOP: Spiritual nursing interventions
6. By asking, How has being sick affected your spiritual practices? the nurse is trying to
determine the need in what spiritual dimension?

a. Sources of hope and strength
b. Spirit-enhancing practices or rituals
c. Involvement in spiritual community
d. Experience of God or transcendence
ANS: B
According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice (2002), asking
the following assessment question helps determine the patients spirit-enhancing practices or
rituals: How has being sick affected your spiritual practices? As a testing strategy, note that
the answer has the spiritual practices and so does the question. Other questions would assess
sources of hope and strength, involvement in the spiritual community, and their experience of
God or transcendence.
PTS: 1
REF: p. 494
OBJ: Assess spiritual needs of patients in the health care setting.
TOP: Spiritual dimension
7. Using a spiritual assessment tool helps the nurse gain more understanding of the patient. What
would be the best question to assess a patients inner strengths?

What gives your life meaning?
Are you motivated to get well?
What do you do to show love for yourself?
What brings you joy and peace in your life?
a.
b.
c.
d.
ANS: D
Asking what brings joy and peace to a persons life is an example of a reflective question to
help increase the awareness of the inner strengths of a patients spiritual process. Such a
question assesses a persons ability to manifest joy. Asking about what gives meaning could
address family and career and not necessarily a patients inner strength. Asking about
motivation and what a person does to show love for themself does not encourage reflection on
inner strengths but asks a question that could be briefly answered.
PTS: 1
REF: p. 494
TOP: Spiritual assessment
8. Determine which of the following situations would be a provider barrier to the nurse
developing cultural competence?

A nurse who is unaware of personal biases to other ethnic groups
No family rooms to accommodate a critically ill patients family
A nurse who seeks encounters with individuals from other cultures
A health care provider who incorporates alternative therapies in health care
a.
b.
c.
d.
ANS: A
A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier.
No family rooms is an example of a system barrier. Nurses who seek encounters with
individuals from other cultures and incorporate alternative therapies into health care have a
developed sense of cultural competence.
PTS: 1
OBJ: List practice issues related to cultural competence.
REF: p. 490
TOP: Culture
9. A manager is educating a group of nurses on the importance of cultural competence. The
manager knows that the teaching has been effective when one of the nurses states:
Cultural competence does not impact patient care.
Cultural competence is not important in health care.
Lack of cultural competence leads to suboptimal patient outcomes.
Lack of cultural competence does not cause active harm to the patient.
a.
b.
c.
d.
ANS: C
Lack of cultural competence is extremely important in health care because it directly impacts
patient care. Lack of cultural competence leads to suboptimal care and can cause active harm
to the patient.
PTS: 1
DIF: Cognitive Level: Evaluation
REF: p. 489
TOP: Culture and spirituality
10. A nurse has an adequate understanding of the barriers to cultural competence when making
which of the following statements?

a. Barriers to cultural competence no longer exist in todays society.
b. The barriers to cultural competence cannot be broken down.
c. Provider barriers include having knowledge about a customs culture regarding
health care.
d. Systems barriers exist when an agencys structure and policies are not designed to
support cultural diversity.
ANS: D
Barriers to cultural competence exist in todays society and can be broken down with the help
of health care providers. Provider barriers include having a lack of knowledge about a
customs culture regarding health care. Systems barriers exist when an agencys structure and
policies are not designed to support cultural diversity.
PTS: 1
REF: p. 490
TOP: Barriers to cultural competence
11. A nurse is attending a lecture on health disparities. The education has been effective when the
nurse states:
a. Inequalities in income and education are the root of many health disparities.
b. Today, there are no longer inequalities preventing access to health care.
c. Low education and low income levels are related to lower rates of health
disparities.
d. Higher income is associated with more health disparities then lower income.
ANS: A
Inequalities in income and education are the root of many health disparities. Individuals with
low education and low income levels often have higher rates of health disparities, and higher
income is associated with less health disparities.
PTS: 1
REF: p. 491
TOP: Health disparities
12. A nurse is working in a disaster area as a volunteer with the local ambulance agency. The
nurse is providing care to a Spanish-speaking patient. What actions can be taken to properly
care for this patient?
a. Use gestures to emphasize what he is saying.
b. Obtain an interpreter.
c. Provide wound care instructions written in English.
d. Treat the patient without speaking to her.
ANS: B
The Office of Minority Health and Disaster Preparedness launched an initiative in 2009 to
help first responders better manage disaster and crises in diverse populations. The nurse can
use this initiative by obtaining an interpreter and providing wound care instructions written in
English. The nurse should not rely on gestures to get his point across or treat the patient
without speaking to her.
PTS:
OBJ:
TOP:
MSC:
1
Office of minority health and disaster preparedness
REF: p. 491
13. A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would
be appropriate for this patient?

a. Asking the patient to reserve prayer for the hospital chaplain
b. Placing the patient by the nurses station because it is busy and will keep the patient
entertained
c. Developing a trusting relationship with the patient
d. Allowing the patients roommate to have visitors late into the night
ANS: C
It is important that the nurse develop a trusting relationship with the patient, as well as being
supportive of the patients needs. The nurse should allow the patient a quiet environment that
allows time for prayer and meditation.
PTS: 1
OBJ: Identify challenges in defining spirituality.
REF: p. 493
TOP: Culturally diverse workforce
14. A nurse is caring for a diabetic patient who frequently uses alternative medicine to manager
ailments. The feels nauseous and requests ginger tea. What should the nurse be aware of
before giving the patient ginger tea?
a. Nothing; natural remedies do not cause unwanted side effects.
b. Ginger can cause blood glucose levels to decrease.
c. Ginger causes blood glucose levels to rise.
d. Ginger can cause a diabetic patient to become more nauseous.
ANS: B
Nurses should be aware of natural remedies and their interactions because more patients turn
to these remedies as opposed to medication for management of ailments. In this scenario, the
nurse should be aware of the fact that ginger can cause blood glucose levels to decrease,
possibly causing harm to the diabetic patient.
PTS: 1
OBJ: Identify challenges in defining spirituality.
REF: p. 496
TOP: Cultural/spiritual assessment
15. A nurse manager is looking for ways to improve the cultural competency of unit staff. Which
action would help the manager accomplish this?

a. Propose voluntary cultural competence training.
b. Hire bicultural clinical and administrative staff.
c. Hire staff from the same ethnic background.
d. Avoid issues pertaining to cultural competence.

ANS: B
The nurse manager can improve the staffs cultural competence by hiring bicultural clinical
and administrative staff to improve education, care delivery, and outcomes. The nurse
manager should also propose mandatory cultural competence training and hire staff from
different ethnic backgrounds.
PTS: 1
REF: p. 490
16. A nurse is educating a patients family on holistic nursing. The nurse judges the teaching as
effective when the family states all of the following except:

Holistic nursing is an attitude.
Holistic nursing is a way of being.
Holistic nursing focuses on healing the person as a whole.
Holistic nursing focuses on healing the system causing ailment.
a.
b.
c.
d.
ANS: D
Holistic nursing is an attitude, a way of being and is focused on healing the person as a whole.
It is not focused on the system causing the ailment.
PTS: 1
REF: p. 496
TOP: Holistic nursing
17. A nurse is gathering data on a patient of a different culture. Which action can the nurse take to
enhance communication while gathering cultural data?

Ignore the patients culture and focus on the reason for hospital admission.
Use hand gestures to get points across to a patient with poor English.
Use close-ended questions to gather information.
Determine the patients level of fluency in English.
a.
b.
c.
d.
ANS: D
The nurse should determine the patients level of fluency in English to enhance
communication. The nurse should not avoid the patients culture during the assessment. Hand
gestures should not be used because they could be offensive to the patient. The nurse should
use open-ended questions or questions phrased in different ways as a method to gather data.
PTS: 1
REF: p. 491
18. The nurse understands that the following organization believes that cultural competence in
nursing is necessary?
a. Nurse Practice Acts of state boards of nursing
b. Code of Ethics of the American Nurses Association
c. Accreditation standards of the National League of Nursing
d. Accreditation standards of The Joint Commission (TJC)
ANS: B
The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to
be sensitive to individual needs. State boards of nursing are involved in the regulation and
licensure of nursing practices. The National League of Nursing is involved with accreditation
of nursing programs. TJC is involved with hospital accreditation.
PTS: 1
DIF: Cognitive Level: Knowledge
REF: p. 490
TOP: Necessity of cultural competence
19. In what culture is it very important for females to be evaluated by female health care
providers?
a. Asian
b. Muslim
c. Hispanic
d. Native American
ANS: B
Muslims have a respect for modesty and avoid nakedness. Having a same-gender health care
provider will help meet their spiritual needs. Native American, Asian, and Hispanic culture
individuals do not have specific issues related to nakedness and modesty.
PTS:
OBJ:
TOP:
MSC:
1
DIF: Cognitive Level: Comprehension
REF: p. 495
Assess spiritual needs of patients in the health care setting.
Cultural and spiritual beliefs affecting nursing
20. The nurse knows that in this culture the older adult is respected and makes the decisions.
a. Asian
c. Native American
b. Hindu
d. African American
ANS: A
In the Asian ethnic group, older family members are honored and respected, and their
authority is unquestioned. The oldest man is the decision maker and spokesman. Native
Americans have strong tries to family and tribe. African Americans and Hindus do not have
any specific practices related to the importance of older family members.
PTS:
OBJ:
TOP:
MSC:
1
REF: p. 495
MULTIPLE RESPONSE
1. The nurse is creating a plan of care for a patient. Which would be important for to consider
before implementing the plan? (Select all that apply.)

The patients lifestyle
The patients insurance coverage
The patients value system
The patients religious beliefs
The patients ability to pay for services
a.
b.
c.
d.
e.
ANS: A, C, D
When creating a plan of care for the patient, the nurse should consider the patients lifestyle,
value system, and religious beliefs.
PTS: 1
REF: p. 494
2. A nurse manager is educating unit staff on cultural competence. The manager knows that the
teaching has been effective when one of the staff members states that cultural competence is
(Select all that apply.)
a. not important in health care.
b. accepting and respecting cultural differences.
c. demonstrating knowledge of the patients culture.
d. demonstrating an understanding of the patients culture.
e. adapting care to be congruent with the patients culture.
ANS: B, C, D, E
Purnell and Paulanka (2009) define cultural competence as accepting and respecting cultural
differences, demonstrating knowledge of the patients culture, demonstrating an understanding
of the patients culture, and adapting care to be congruent with the patients culture.
PTS: 1
REF: p. 490
3. Which action by the nurse shows cultural competence of Native American culture? (Select all
that apply.)
Refuse to allow rituals to be practiced at the bedside.
Allow the family to bring in a medicine man for healing.
Allow the family and patient time for prayer.
Provide space for rituals.
Work hard to gain trust.
a.
b.
c.
d.
e.
ANS: B, C, D, E
The nurse can show culturally competent care of an American Indian patient by allowing the
family to bring in a medicine man, allowing time for prayer, providing space for rituals, and
working hard to gain trust.
PTS: 1
REF: p. 495
4. Which statement by the nurse shows understanding of the Vietnamese culture? (Select all that
apply.)
Vietnamese are slow to trust authority figures.
Vietnamese have a very patriarchal society.
Vietnamese will try home remedies before seeking Western medicine.
Vietnamese are often compliant with Western treatment one sought.
Vietnamese are generally noncompliant with health care.
a.
b.
c.
d.
e.
ANS: A, B, C, D
The nurse shows understanding of Vietnamese culture by stating that the Vietnamese are slow
to trust authority figures, a very patriarchal society, will try home remedies before seeking
Western medicine, and are often compliant with Western treatment once sought.
PTS: 1
REF: p. 495
5. A nurse is educating a student nurse on African American culture. The nurse judges the
teaching to be effective when the student nurse states that African Americans (Select all that
apply.)
a. have extended family that has a great influence on the patient.
b. honor and respect older family members.
c. have the oldest woman as the decision maker.
d. do not disagree with health care recommendations.
e. dont always follow up with health care recommendations.
ANS: A, B, D, E
The teaching has been effective when the student nurse states that African Americans have
extended family that has a great influence on the patient, older family members are honored
and respected, do not disagree with health care recommendations, and dont always follow up
with health care recommendations. The oldest man is the decision maker.
PTS: 1
REF: p. 494
6. The nurse has an adequate understanding of Japanese culture when stating which of the
following? (Select all that apply.)

a. The Japanese believe that contact with blood, skin diseases, and corpses causes
b.
c.
d.
e.
illness.
The Japanese believe in healers and herbalists.
The Japanese have high regard for physicians.
The Japanese tend to not question the care of the physician.
The Japanese verbally express pain.
ANS: A, B, C, D
The nurse has an adequate understanding of Japanese culture when stating that the Japanese
believe that contact with blood, skin diseases, and corpses causes illness; have high regard for
physicians; and often do not question their care. The Japanese do not express pain, believing
that it is a virtue to bear pain.
PTS: 1
REF: p. 494
Zerwekh: Nursing Today, 7th Edition

Test Bank
MULTIPLE CHOICE
1. What organization believes that cultural competence in nursing is
necessary?
ANS: B
The American Nurses Association indicates in its Code of Ethics the
necessity of the nurse to be sensitive to individual needs. State boards of
nursing are involved in the regulation and licensure of nursing practices.
The National League of Nursing is involved with accreditation of nursing
programs. TJC is involved with hospital accreditation.
DIF: Cognitive Level: Knowledge REF: p. 463
TOP: Necessity of cultural competence MSC:
NCLEX:
Psychosocial integrity
2. What is a characteristic of a culturally competent nurse?
b. Tries to treat all patients the same
ANS: D
One model of cultural competence has five aspects. They include cultural
awareness, cultural knowledge, cultural skill, cultural encounter, and
cultural desire. Cultural knowledge is seeking and obtaining information
regarding different cultural and ethnic groups. The other options are
applicable to quality nursing care.
REF:
p. 463
OBJ: Define cultural competence. TOP: Cultural competence
b. No sinks in every patient room
d. A strict and enforced policy against more than one visitor in the
ICU
ANS: D
System barriers are due to the agencys structure and policies, which do
not support cultural diversity. A strict and enforced ICU visitor policy, for
example, will impact those cultures with a strong emphasis on the
extended family. Provider barriers are those such as a nurse may have,
including lack of information about a culture. Including kosher diet options
on the menu and making changes to room environments (including privacy
curtains and sinks in every room) are provider barriers that can be
addressed.
DIF:
OBJ:
TOP:
MSC:
Cognitive Level: Analysis

REF: p. 463
System barriers to cultural competence
4. Health care disparities can be caused by which patient variable?

b. Provider/patient relationships
ANS: A
Disparities in health care can include both provider and patient variables.
Patient variables are mistrust of the health care system and refusal of
treatment.
DIF: Cognitive Level: Knowledge REF: p. 465
OBJ: Determine cultural and spiritual beliefs of patients in the health care
setting.
5. Which would have little to no impact in helping resolve health care
disparities?
a. Research on life stressors
b. Access to basic health care
c. Increasing diversity of health care workers
d. Health promotion and wellness programs
ANS: A
Some solutions to help resolve health care disparities include the
following: increasing the diversity of health care providers; ensuring that
all people have access to affordable, basic health care; promoting wellness
and a healthy lifestyle; strengthening provider/patient relationships;
increasing cultural competency of health care providers; and conducting
research to determine why certain diseases affect minorities so greatly
and to discover effective intervention strategies. Research on life stressors
does not have an impact on resolving health care disparities.
REF:
p. 465
setting.
MSC:
NCLEX:
6. Based on assessment data, the nursing diagnosis for a patient is spiritual
distress related to loneliness/social alienation. What would be included in
spiritual nursing interventions?
ANS: A
Active listening is an example of a spiritual nursing intervention. Other
interventions include the following: prayer, presence, scripture reading,
peaceful environment, meditation, music, pastoral care, inspiring hope,
validation of the patients thoughts and feelings, values clarification,
sensitive responses to patient beliefs, and developing a trusting
relationship. Identifying level of functioning and ADLs address basic human
needs. Evaluating the ability to understand events is addressing cognitive
function.
DIF: Cognitive Level: Application REF: p. 467
setting.
MSC:
NCLEX:
7. The nurse knows that in which culture is the older adult respected and
makes the decisions?
a. Asian
b. Hindu
c. American Indian
d. African-American
ANS: A
In the Asian ethnic group, older family members are honored and
respected, and their authority is unquestioned. The oldest male is the
decision maker and spokesman. The American Indian has strong ties to
family and tribe. African-American and Hindu do not have any specific
practices related to the importance of the older family member.
DIF:
OBJ:
TOP:
MSC:
Cognitive Level: Comprehension

REF:
p. 468
8. By asking, How has being sick affected your spiritual practices? the
nurse is trying to determine the need in what spiritual dimension?

ANS: B
According to Taylor in Spiritual Care: Nursing Theory, Research, and
Practice (2002), asking the following assessment question helps determine
the patients spirit-enhancing practices or rituals: How has being sick
affected your spiritual practices? As a testing strategy, note that the
answer has the spiritual practices and so does the question. Other
questions would assess sources of hope and strength, involvement in the
spiritual community and their experience of God or transcendence.
REF: p. 472
TOP: Spiritual dimension
MSC:
NCLEX:
9. Using a spiritual assessment tool helps the nurse gain more understanding
of the patient. What would be the best question to assess a patients inner
strengths?
a. What gives your life meaning?
b. Are you motivated to get well?
c. What do you do to show love for yourself?
d. What brings you joy and peace in your life?
ANS: D
Asking what brings joy and peace to a persons life is an example of a
reflective question to help increase the awareness of the inner strengths of
a patients spiritual process. Such a question assesses a persons ability to
manifest joy. Asking about what gives meaning could address family and
career and not necessarily a patients inner strength. Asking about
motivation and what a person does to show love for himself or herself does
not encourage reflection on inner strengths but asks a question that could
be briefly answered.
DIF: Cognitive Level: Application REF: p. 473
TOP: Spiritual assessment
MSC:
NCLEX:
10. Which of the following would be a provider barrier to the nurse developing
cultural competence?
a. A nurse who is unaware of his or her own biases to other ethnic
groups
b. No family rooms to accommodate a critically ill patients family
c. A nurse who seeks encounters with individuals from other
cultures
d. A health care provider that incorporates alternative therapies in

health care
ANS: A
A nurse who is unaware of his or her own biases to other ethnic groups
represents a provider barrier. No family rooms is an example of a system
barrier. Nurses who seek encounters with individuals from other cultures
and incorporate alternative therapies into health care have a developed
sense of cultural competence.
REF:
p. 463
OBJ: List practice issues related to cultural competence. TOP: Culture
MATCHING
Match the cultural and spiritual beliefs about illness with the specific
group.
a. Strong ties to family and tribe
b. Illness may be a punishment or is due to voodoo or spirits
c. Physical contact with blood and kin conditions may cause illness
d. Slow to trust authority due to refugee experience
e. Older family members honored
f. Reluctant to discuss health problems because it may bring shame
to family
g. May wear copper and silver bracelets to prevent illness
h. If family has history of mental retardation, may reduce chance of
one getting married
1.
2.
3.
4.
5.
6.
7.
8.
Asian/Pacific Islander
Chinese
Japanese
Hindu and Muslim
Vietnamese
Hispanic/Latino
African-American
American Indian
1. ANS:
OBJ:
MSC:
2. ANS:
OBJ:
MSC:
3. ANS:
OBJ:
MSC:
A
F
C
REF: p. 468
TOP: Culture
REF: p. 468
TOP: Culture
REF: p. 468
TOP: Culture
4. ANS:
OBJ:
MSC:
5. ANS:
OBJ:
MSC:
6. ANS:
OBJ:
MSC:
7. ANS:
OBJ:
MSC:
8. ANS:
OBJ:
MSC:
H
D
E
B
A
REF: p. 469
TOP: Culture
REF: p. 469
TOP: Culture
REF: p. 469
TOP: Culture
REF: p. 469
TOP: Culture
REF: p. 469
TOP: Culture
Zerwekh: Nursing Today, 6th Edition
Test Bank
MULTIPLE CHOICE
1. What organization believes that cultural competence in nursing is necessary?

ANS: B
The American Nurses Association indicates in its Code of Ethics the necessity of
the nurse to be sensitive to individual needs. State boards of nursing are involved
in the regulation and licensure of nursing practices. The National League of
Nursing is involved with accreditation of nursing programs. TJC is involved with
hospital accreditation.

competence
OBJ: List practice issues related to cultural
TOP: Necessity of cultural competence

integrity
MSC:
NCLEX: Psychosocial
2. What is a characteristic of a culturally competent nurse?

b. Tries to treat all clients the same
ANS: D
One model of cultural competence has five aspects. They include cultural
awareness, cultural knowledge, cultural skill, cultural encounter, and cultural
desire. Cultural knowledge is seeking and obtaining information regarding
different cultural and ethnic groups. The other options are applicable to quality
nursing care.
OBJ:
Define cultural competence
TOP: Cultural competence

integrity
MSC:
NCLEX: Psychosocial

b. No sinks in every client room
d. A strict and enforced policy against more than one visitor in the ICU
ANS: D
System barriers are due to the agencys structure and policies, which do not
support cultural diversity. A strict and enforced ICU visitor policy, for example, will
impact those cultures with a strong emphasis on the extended family.

competence
OBJ: List practice issues related to cultural
TOP: System barriers to cultural competence

4. Health care disparities can be caused by which client variable?

b. Provider/client relationships
ANS: A
Disparities in health care can include both provider and client variables. Client
variables are mistrust of the health care system and refusal of treatment.
OBJ: Determine cultural and spiritual beliefs of clients in the health care setting
integrity
MSC:
NCLEX: Psychosocial
5. Which would have little to no impact in helping resolve health care disparities?
a. Research on life stressors
b. Access to basic health care
c. Increasing diversity of health care workers
d. Health promotion and wellness programs
ANS: A
Some solutions to help resolve health care disparities include the following:
increasing the diversity of health care providers; ensuring that all people have
access to affordable, basic health care; promoting wellness and a healthy
lifestyle; strengthening provider/client relationships; increasing cultural
competency of health care providers; and conducting research to determine why
certain diseases affect minorities so greatly and to discover effective intervention
strategies.
OBJ: Determine cultural and spiritual beliefs of clients in the health care setting
integrity
MSC:
NCLEX: Psychosocial
6. Based on assessment data, the nursing diagnosis for a client is Spiritual distress
related to loneliness/social alienation. What would be included in spiritual nursing
interventions?
ANS: A
Active listening is an example of a spiritual nursing intervention. Other
interventions include the following: prayer, presence, scripture reading, peaceful
environment, meditation, music, pastoral care, inspiring hope, validation of the
clients thoughts and feelings, values clarification, sensitive responses to client
beliefs, and developing a trusting relationship.
OBJ: Determine cultural and spiritual beliefs of clients in the health care setting.
integrity
MSC:
NCLEX: Psychosocial
7. In what culture is it very important for females to be evaluated by female health

care providers?
a. Asian
b. Muslim
c. Hispanic
d. Native American
ANS: B
Muslims have a respect for modesty and avoid nakedness. Having a same-gender
health care provider will help meet their spiritual needs.
OBJ: Assess spiritual needs of clients in the health care setting
TOP: Cultural and spiritual beliefs affecting nursing
8. The nurse knows that in this culture the elderly are respected and make the
decisions.
a. Asian
b. Hindu
c. Native American
d. African-American
ANS: A
In the Asian ethnic group, older family members are honored and respected, and
their authority is unquestioned. The oldest male is the decision maker and
spokesman.
OBJ: Assess spiritual needs of clients in the health care setting
TOP: Cultural and spiritual beliefs affecting nursing
9. By asking, How has being sick affected your spiritual practices? the nurse is
trying to determine the need in what spiritual dimension?
ANS: B
According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice
(2002), asking the following assessment question helps determine the clients
spirit-enhancing practices or rituals: How has being sick affected your spiritual
practices?
OBJ: Assess spiritual needs of clients in the health care setting TOP: Spiritual
dimension
10. Using a spiritual assessment tool helps the nurse gain more understanding of the
client. What would be the best question to assess a clients inner strengths?
a. What gives your life meaning?
b. Are you motivated to get well?
c. What do you do to show love for yourself?
d. What brings you joy and peace in your life?
ANS: D
This is a reflective question to help increase the awareness of the inner strengths
of a clients spiritual process. Such a question assesses a persons ability to
manifest joy.
OBJ: Assess spiritual needs of clients in the health care setting TOP: Spiritual
assessment
11. Which of the following would be a provider barrier to the nurse developing
cultural competence?
a. A nurse who is unaware of his or her own biases to other ethnic groups
b. No family rooms to accommodate a critically ill clients family
c. A nurse who seeks encounters with individuals from other cultures
d. A health care provider that incorporates alternative therapies in health
care
ANS: A
A nurse who is unaware of his or her own biases to other ethnic groups represents
a provider barrier. No family rooms is an example of a system barrier.
to cultural competence
TOP: Culture
OBJ:
List practice issues related
MATCHING
Match the cultural and spiritual beliefs about illness with the specific group.
1. Strong ties to family and tribe

2. Illness may be a punishment or is due to voodoo or spirits
3. Physical contact with blood, skin conditions may cause illness
4. Slow to trust authority due to refugee experience
5. Older family members honored
6. Reluctant to discuss health problems because it may bring shame to family
7. May wear copper and silver bracelets to prevent illness

8. If family has history of mental retardation, may reduce chance of one getting
married
a.
Asian/Pacific Islander
b.
Chinese
c.
Japanese
d.
Hindu and Muslim
e.
Vietnamese
f.
Hispanic/Latino
g.
African-American
h.
American Indian
1. ANS: H
OBJ: List practice issues related to cultural competence
TOP: Culture

2. ANS: G
TOP: Culture

3. ANS: C
TOP: Culture

4. ANS: E

TOP: Culture
5. ANS: F
TOP: Culture

6. ANS: B
TOP: Culture

7. ANS: A
TOP: Culture

8. ANS: D

TOP: Culture

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Chapter 21: Cultural and Spiritual Awareness

3. Which of the following actions cause health care disparities?

loneliness or social alienation. What would be included in spiritual nursing interventions?

a. Participate in active listening.

Active listening is an example of a spiritual nursing intervention. Other interventions include

determine the need in what spiritual dimension?

would be the best question to assess a patients inner strengths?

developing cultural competence?

9. A manager is educating a group of nurses on the importance of cultural competence. The

which of the following statements?

be appropriate for this patient?

action would help the manager accomplish this?

d. Avoid issues pertaining to cultural competence.

effective when the family states all of the following except:

enhance communication while gathering cultural data?

before implementing the plan? (Select all that apply.)

following? (Select all that apply.)

Zerwekh: Nursing Today, 7th Edition

Cognitive Level: Analysis

4. Health care disparities can be caused by which patient variable?

Cognitive Level: Comprehension

b. Spirit-enhancing practices or rituals

d. A health care provider that incorporates alternative therapies in

Zerwekh: Nursing Today, 6th Edition

Chapter 21: Cultural and Spiritual Awareness

1. What organization believes that cultural competence in nursing is necessary?

DIF: Cognitive Level: Knowledge

OBJ: List practice issues related to cultural

TOP: Necessity of cultural competence

2. What is a characteristic of a culturally competent nurse?

Define cultural competence

TOP: Cultural competence

3. What is an example of a system barrier to cultural competence?

DIF: Cognitive Level: Analysis

OBJ: List practice issues related to cultural

TOP: System barriers to cultural competence

4. Health care disparities can be caused by which client variable?

7. In what culture is it very important for females to be evaluated by female health

MSC: NCLEX: Psychosocial integrity

List practice issues related

MSC: NCLEX: Psychosocial integrity

1. Strong ties to family and tribe

7. May wear copper and silver bracelets to prevent illness

Hindu and Muslim

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

MSC: NCLEX: Psychosocial integrity

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

MSC: NCLEX: Psychosocial integrity

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

MSC: NCLEX: Psychosocial integrity

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

MSC: NCLEX: Psychosocial integrity

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence

MSC: NCLEX: Psychosocial integrity

DIF: Cognitive Level: Comprehension

OBJ: List practice issues related to cultural competence