Silvestri: Saunders Comprehensive Review for the NCLEX-PN®

Examination, 4th Edition

Chapter 6: Cultural Diversity

Test Bank

MULTIPLE CHOICE

1. A nurse is providing discharge instructions to a Chinese client regarding prescribed

dietary modifications. During the teaching session the client continually turns away from
the nurse. Which of the following nursing actions is most appropriate?
1. Continue with the instructions, verifying client understanding.
2. Identify the importance of the instructions for the maintenance of health care.
3. Walk around the client so that the nurse continually faces the client.
4. Give the client a dietary booklet and return later to continue with the instructions.
ANS: 1
Rationale: Most Chinese maintain a formal distance with each other, which is a form of
respect. Many Chinese are uncomfortable with face-to-face communications, especially
when there is direct eye contact. If the client turns away from the nurse during a
conversation, the best action is to continue with the conversation. Walking around the
client so that the nurse faces the client is in direct conflict with the cultural practice.
Identifying the importance of the instructions for the maintenance of health care may be
viewed as degrading. Returning later to continue with the explanation may be viewed as a
rude gesture.
Test-Taking Strategy: Understanding the characteristics of this cultural group will assist
in answering the question. Use the process of elimination. Eliminate options 2 and 4 first
because these are nontherapeutic actions. From the remaining two options, note that
option 1 is the most therapeutic. If you had difficulty with this question, review the
communication practices of this cultural group.

DIF: Level of Cognitive Ability: Application

REF: Giger, J., & Davidhizar, R. (2004). Transcultural nursing: Assessment and
intervention. St. Louis: Mosby. OBJ: Client Needs: Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Teaching and Learning

2. A nurse is assisting in preparing a plan of care for a client who is a Jehovah’s Witness.
The client has been told that surgery is necessary. Considering the client’s religious
preferences, the nurse documents that:
1. Surgery is prohibited in this religious group.
2. The administration of blood and blood products is forbidden.
3. Medication administration is not allowed.
4. Faith healing is primarily practiced.
ANS: 2
 Test Bank 6-2

Rationale: In the Jehovah’s Witness religion, surgery is not opposed, but the
administration of blood and blood products is forbidden. Medication is an acceptable
practice except if the medication is derived from blood products. Faith healing is
forbidden in this religious group.
Test-Taking Strategy: Understanding the characteristics of this religious group will assist
in answering the question. Remember that the administration of blood and any associated
blood products is forbidden in this religion. Review the characteristics of this religious
group if you had difficulty with this question.

DIF: Level of Cognitive Ability: Comprehension

REF: Nies, M., & McEwen, M. (2007). Community health nursing: Promoting the
health of populations (4th ed.). St. Louis: Saunders. OBJ: Client Needs:
Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Implementation

3. A nurse is preparing to deliver a food tray to a client whose religion is Judaism. The nurse
checks the food on the tray and notes that the client has received a roast beef dinner with
whole milk as a beverage. Which of the following actions will the nurse take?
1. Deliver the food tray to the client.
2. Call the dietary department and ask for a new meal tray.
3. Replace the whole milk with fat-free milk.
4. Ask the dietary department to replace the roast beef with pork.
ANS: 2
Rationale: In the Jewish religion, the dairy-meat combination is not acceptable. Pork and
pork products are not allowed in the traditional Jewish religion. The only correct nursing
action is to ask the dietary department to deliver a new meal tray.
Test-Taking Strategy: Use the process of elimination and knowledge that the dairy-meat
combination is not acceptable in this religion to answer the question. This knowledge will
assist in eliminating options 1, 3, and 4. Also note that option 2 is the umbrella option.
Review the dietary rules of this religious group if you had difficulty with this question.

DIF: Level of Cognitive Ability: Application

REF: Harkreader, H., & Hogan, M. (2007). Fundamentals of nursing (3rd ed.). St.
Louis: Saunders. OBJ: Client Needs: Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Implementation

4. A nurse educator is describing the yin and yang theory of the ancient Chinese philosophy
of Tao to a group of nursing students. The nurse explains that foods are classified as hot
and cold in this theory and are transformed into yin and yang energy when metabolized
by the body. The nursing student understands this theory when the student verbalizes that
a client who practices this belief:
1. Consumes cold foods when a “hot” illness is present
2. Consumes hot foods when a “hot” illness is present
3. Believes that yin foods are hot foods
 Test Bank 6-3

4. Believes that yang foods are cold foods

ANS: 1
Rationale: In the yin and yang theory, health is believed to exist when all aspects of the
person are in perfect balance. Foods are classified as hot or cold and are transformed into
yin and yang energy when metabolized by the body. Yin foods are cold, and yang foods
are hot. Cold foods are eaten when one has a hot illness and hot foods are eaten when one
has a cold illness.
Test-Taking Strategy: Knowledge regarding the theory of yin and yang is required to
answer this question. Remember that yin foods are cold and yang foods are hot; cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a cold
illness. Review this theory if you are unfamiliar with it.

DIF: Level of Cognitive Ability: Comprehension

REF: Nies, M., & McEwen, M. (2007). Community health nursing: Promoting the
health of populations (4th ed.). St. Louis: Saunders. OBJ: Client Needs:
Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Teaching and Learning

5. A nurse is planning to instruct the Hispanic-American client about nutrition and dietary
restrictions. When developing the plan for the instructions, the nurse is aware that this
ethnic group:
1. Enjoys foods that lack color, flavor, and texture
2. Primarily eats raw fish
3. Enjoys eating red meat
4. Views food as a primary form of socialization
ANS: 4
Rationale: Mexican foods are rich in color, flavor, texture, and spiciness. In the Mexican
culture, any occasion is seen as a time to celebrate with food and enjoy the
companionship of family and friends. Because food is a primary form of socialization in
the Mexican culture, Hispanic Americans may have difficulty adhering to a prescribed
diet. Asian Americans eat raw fish, rice, and soy sauce. European Americans prefer
carbohydrates and red meat.
Test-Taking Strategy: Knowledge regarding the food practices and preferences and the
meaning of food in the Hispanic-American culture is required to answer this question.
Remember that food is a primary form of socialization in the Mexican culture. If you had
difficulty with this question, review the food preferences associated with this culture.

DIF: Level of Cognitive Ability: Comprehension

REF: Giger, J., & Davidhizar, R. (2004). Transcultural nursing: Assessment and
intervention. St. Louis: Mosby. OBJ: Client Needs: Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Planning
 Test Bank 6-4

6. A nursing student is discussing cultural issues in a clinical conference. The nursing

instructor asks the student to describe ethnocentrism. Which of the following if stated by
the student indicates a lack of understanding of the issue of ethnocentrism?
1. “It is a tendency to view one’s own ways as best.”
2. “It is acting in a manner that is superior to other cultures.”
3. “It is believing that one’s own ways are the only acceptable way.”
4. “It is imposing one’s beliefs on individuals from another culture.”
ANS: 4
Rationale: Ethnocentrism is a tendency to view one’s own ways of life as the most
desirable, acceptable, or best and to act in a superior manner toward another culture.
Cultural imposition is the tendency to impose one’s own beliefs, values, and patterns of
behavior on individuals from another culture.
Test-Taking Strategy: Note the strategic words “lack of understanding.” Use the process
of elimination, and note that options 1, 2, and 3 are comparable or alike. Additionally,
knowledge of the concept of ethnocentrism will direct you to option 4. If you had
difficulty with this question, review culturally related concepts.

DIF: Level of Cognitive Ability: Comprehension

REF: Nies, M., & McEwen, M. (2007). Community health nursing: Promoting the
health of populations (4th ed.). St. Louis: Saunders. OBJ: Client Needs:
Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Teaching and Learning

7. A nurse is assigned to collect data from a Hispanic-American client during the hospital
admission. On initial meeting of the client, the nurse should plan to:
1. Greet the client with a handshake.
2. Avoid touching the client.
3. Avoid any affirmative nods during the conversations with the client.
4. Smile and use humor throughout the entire admission process.
ANS: 1
Rationale: To demonstrate respect, compassion, and understanding, health care providers
should greet Hispanic-American clients with a handshake. On establishing rapport,
providers may further demonstrate approval and respect through touch, smiling, and
affirmative nods of the head. Given the diversity of dialects and the nuances of language,
culturally congruent use of humor is difficult to accomplish and therefore should be
avoided.
Test-Taking Strategy: Knowledge regarding the cultural communication patterns of the
Hispanic American is required to answer this question. Note the strategic words “initial
meeting.” Reading each option carefully and focusing on these strategic words will direct
you to option 1. Review the characteristics of this cultural group if you had difficulty
with this question.

DIF: Level of Cognitive Ability: Application

REF: Giger, J., & Davidhizar, R. (2004). Transcultural nursing: Assessment and
 Test Bank 6-5

intervention. St. Louis: Mosby. OBJ: Client Needs: Psychosocial Integrity

TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Planning

8. A nurse is providing care to a Cuban-American client who is terminally ill. Numerous

family members are present most of the time, and many of the family members are very
emotional. The most appropriate nursing plan is to:
1. Restrict the number of family members visiting at one time.
2. Inform the family that emotional outbursts are to be avoided.
3. Request permission to move the client to a private room, and allow the family
members to visit.
4. Contact the physician to speak to the family regarding their behavior.
ANS: 3
Rationale: In the Cuban culture, loud crying and other physical manifestations of grief
are considered socially acceptable. Of the options provided, option 3 is the only option
that identifies a culturally sensitive approach on the part of the nurse. Options 1, 2, and 4
are inappropriate nursing interventions.
Test-Taking Strategy: Focus on the client(s) in the question, who are the family
members. Use the process of elimination, recalling the characteristics of the culture and
the importance of cultural sensitivity. This will direct you to option 3. If you had
difficulty with this question, review the characteristics of this culture.

DIF: Level of Cognitive Ability: Application

REF: Giger, J., & Davidhizar, R. (2004). Transcultural nursing: Assessment and
intervention. St. Louis: Mosby. OBJ: Client Needs: Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Planning

9. A nurse is instructing a Native-American client regarding the procedure for collecting a

urine sample. The nurse observes that the client continually stares at the floor during the
instructional session. The nurse interprets this behavior as:
1. Rude
2. Disinterest
3. Embarrassment
4. Indicative that the client is paying close attention
ANS: 4
Rationale: Native-American clients often stare at the floor when a nurse is talking. This
culturally appropriate behavior indicates that the listener is paying close attention to the
speaker. Options 1, 2, and 3 are inappropriate interpretations of the client’s behavior.
Test-Taking Strategy: Knowledge regarding the culturally appropriate behaviors of
Native-American clients is required to answer this question. Remember that Native-
American clients often stare at the floor when a nurse is talking. This knowledge will
direct you to option 4. If you had difficulty with this question, review the characteristics
of this culture.
Test Bank 6-6

DIF: Level of Cognitive Ability: Comprehension

REF: Nies, M., & McEwen, M. (2007). Community health nursing: Promoting the
health of populations (4th ed.). St. Louis: Saunders. OBJ: Client Needs:
Psychosocial Integrity
TOP: Content Area: Fundamental Skills
MSC: Integrated Process: Nursing Process/Evaluation