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Chapter 10, Cultural Assessment

MULTIPLE CHOICE

1. What was the primary reason that the American Nurses Association and other
accrediting agencies developed the National Standards for Culturally and Linguistically
Appropriate Services in Health Care?
A) The composition of the United States is multicultural.
B) Ethnicity in nursing is part of the holistic process.
C) Unless cultural differences are addressed, many clients do not respond well to
nurses.
D) Nurses need to understand every aspect of various cultures to provide good care to
all clients.
ANS: A
Feedback: The American Nurses Association, Joint Commission, American
Psychological Association, and other accrediting agencies direct nurses to acknowledge
and address the biopsychosocial and spiritual needs of clients. This is because the
composition of the United States is multicultural. Ethnicity is not part of the holistic
process. Clients may not respond well to nurses even when cultural differences are
addressed. It is necessary to understand cultural differences when providing nursing care
to specific cultures, but no nurse can know every aspect of all the different cultural
groups encountered.

PTS: 1
REF: Page: 216 | Header: Cultural Assessment and Cultural Competency
OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember

2. What would be the student's most appropriate response when asked by the preceptor
what is the most important assessment when considering the overall health care provided
a multiethnic population?
A) Transcultural
B) Community
C) Mobility
D) Family
ANS: A
Feedback: Improving cultural competence among health care providers could not only
help improve health equity but also increase patient satisfaction, improve quality and
safety, and meet legislative and regulatory standards A specific example of a
comprehensive nursing assessment that attends to both social and cultural dimensions is
the transcultural assessment. A community assessment would be most important if the
client's health issues were caused or impacted by the community in which he/she lives.
Mobility and family assessments could be useful, but these aspects can also be addressed
through a transcultural assessment.

PTS: 1 REF: Page: 218 | Header: Aims of Cultural Assessment


OBJ: 2 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply

3. The nurse begins the community assessment process for a small town with an
assessment of what relationship?
A) The community's social support and marriage rates
B) The community's level of education and rates of chronic illness
C) The community's living conditions and divorce rate
D) The community's median family income and rate of high school graduation
ANS: B
Feedback: Ideally, the process of community assessment begins with an assessment of
various social, economic, environmental, and quality-of-life health indicators and their
relationship with the community's health concerns. Examples of findings from a
community social assessment include the relationship between social determinants of
health (family income, level of education, social support, and living conditions) and
chronic illness. None of the other options focus on health-related issues.

PTS: 1 REF: Page: 229 | Header: Social Assessment of the Community


OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Culture and Spirituality
BLM: Cognitive Level: Apply

4. What is a mandated goal included in Anderson and McFarlane's Community as Partner


Assessment Model?
A) Transcultural assessment of community allies
B) Social assessment of community leaders as individuals
C) Systemic evaluation to identify the effects of interventions
D) Community evaluation to identify interventions in communities
ANS: C
Feedback: Anderson and McFarlane's model mandates that every community assessment
and intervention include systematic evaluation to identify the effects of interventions.
None of the other statements accurately describe a mandated goal.

PTS: 1 REF: Page: 231 | Header: Social Assessment of the Community


OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

5. A shared, learned, and symbolic system of values, beliefs, and attitudes that shape and
influence how people see and behave in the world is a definition of what?
A) Society
B) Community
C) System
D) Culture
ANS: D
Feedback: At the most basic level, culture can be defined as a shared, learned, and
symbolic system of values, beliefs, and attitudes that shape and influence how people see
and behave in the world. Society is defined as a group of people bound by a common
culture. Community is defined as a group of people having a common interest. System is
defined as a group of interrelated elements forming a complex whole.

PTS: 1 REF: Page: 217 | Header: Characteristics of Culture


OBJ: 3 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Remember

6. A new graduate nurse, attending a hospital orientation, is asked to explain what the goals
of a cultural assessment include. What would be the graduate nurse's best answer?
A) Developing and implementing a culturally congruent plan of care
B) Comparing social care needs of the specific person
C) Acquiring knowledge about the community's cultural beliefs and practices
D) Comparing social and health beliefs of public health agencies
ANS: A
Feedback: The specific aim of cultural assessment is to provide an all-inclusive picture
of the client's culture-based health care needs by (1) gaining knowledge about the client's
cultural beliefs and practices; (2) comparing culture care needs of the specific person
with the general themes of those of similar cultural background; (3) identifying
similarities and differences among the cultural beliefs of the client, health care agency,
and nurse; and (4) generating a holistic picture of the client's care needs, upon which a
culturally congruent nursing care plan is developed and implemented. The remaining
options are associated with components of an effective cultural assessment.

PTS: 1
REF: Page: 217 | Header: Leininger's Cultural Care Diversity and Universality
Theory/Model OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

7. Madeline Leininger identified attributes and behaviors that a nurse practicing effective
care across cultures must have. What statement is reflective of Leininger's theory?
A) The nurse's own beliefs always interfere with cultural sensitive care.
B) Use of active listening by the nurse is fundamental to effective care.
C) Awareness of meanings behind the client's social communications is of minor
importance.
D) Use of body language is not recommended when providing cultural sensitive
nursing care.
ANS: B
Feedback: Leininger suggests that the attributes and behaviors of a nurse practicing
effective care within the client's cultural context include genuine interest in a client's
culture and personal life experiences, active listening, and awareness of meanings behind
the client's verbal communication (story telling); nonverbal communication (body
language, eye contact, facial expressions, interpersonal space, and preferences regarding
touch); and acknowledgment that the nurse's own beliefs and prejudices might create
barriers to providing culturally sensitive care.

PTS: 1
REF: Page: 217 | Header: Leininger's Cultural Care Diversity and Universality
Theory/Model OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

8. When caring for a client from a culturally different background, what is the goal for
incorporating the client's health beliefs and practices into the nursing plan of care?
A) To enhance the client's social system
B) To enhance cultural connectedness
C) Improvement of the client's health outcomes
D) Improvement of communication with the client and family
ANS: C
Feedback: Consideration of clients' cultural background and incorporating health beliefs
and practices in care plans contributes to enhanced client experiences with health care
and improves health outcomes. Incorporating the client's health beliefs and practices will
not enhance this client's social system, cultural connectiveness or improve
communication with the family.

PTS: 1 REF: Page: 228 | Header: Social Assessment of the Individual


OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Caring
BLM: Cognitive Level: Analyze

9. Matters of the human soul are referred to as what?


A) Culture
B) Ethnicity
C) Values and beliefs
D) Spirituality
ANS: D
Feedback: Spirituality, in the most fundamental sense, pertains to matters of the human
soul, be it a state of mind, a state of being in the world, a journey of self-discovery, or a
place outside the five senses. Culture can be defined as a shared, learned, and symbolic
system of values, beliefs, and attitudes that shapes and influences the way people see and
behave in the world. Ethnicity is one's self-defined race. Values and beliefs are those
things that a person or culture sees as having worth.

PTS: 1
REF: Page: 225 | Header: Assessment of Spirituality and Religious Beliefs
OBJ: 4 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Remember

10. A hospice nurse is admitting a new client who states, “I'm not religious but considers
myself spiritual”. What change in attitude has been noted when illness stresses such a
client's beliefs and values?
A) Religious activities may lose importance.
B) Religious activities may take a central position in life.
C) Religious activities may blend with national identity.
D) Religious activities may become formalized.
ANS: B
Feedback: Even when daily prayers or other religious practices are not a routine part of a
client's life, they often take a central position during life transitions, such as loss of a
loved one, accident, or serious illness. The other options are distracters to the question.
None of the other options are as likely to occur.

PTS: 1
REF: Page: 225 | Header: Assessment of Spirituality and Religious Beliefs
OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand

11. A nursing student is helping with a group presentation on social assessment. What would
be a foundational concept for the student to include in the group presentation?
A) Social assessment emphasizes the interconnectedness of physical, physiologic, and
educational dimensions of health.
B) Social assessment emphasizes the interconnectedness of physical, family, and
social dimensions of health.
C) Social assessment emphasizes the interconnectedness of physical, spiritual, and
psychic dimensions of health.
D) Social assessment emphasizes the interconnectedness of physical, psychosocial,
and spiritual dimensions of health.
ANS: D
Feedback: Social assessment, integral to quality nursing care at every level, emphasizes
the interconnectedness of physical, psychosocial, and spiritual dimensions of health for
individuals, communities, and populations studied. Psychic, social, and educational
dimensions are not dimensions of health emphasized in the social assessment.

PTS: 1 REF: Page: 228 | Header: Social Assessment


OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Analyze

12. A woman newly immigrated to the United States is admitted to the obstetric unit. While
doing a transcultural assessment, how would the nurse individualize questions for this
client?
A) Assessing if the client speaks and understands English
B) Realizing that some women are not allowed an education in their home country
C) Requesting a professional translator fluent in the woman's language
D) Directing assessment questions only with the client's husband or family members
ANS: A
Feedback: To best address individualization during a transcultural assessment with this
client is to determine the degree to which she effectively speaks and understands
English. The nurse would need this information prior to asking for a translator, assuming
the client was not allowed an education, or talking only with the husband.

PTS: 1 REF: Page: 218 | Header: Cultural Data Collection


OBJ: 3 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply

13. Madeline Leininger formulated a theory that highlights what?


A) Social behaviors in a community
B) Nursing behaviors necessary to carry out an effective cultural assessment
C) Nursing behaviors that compare personal philosophies of life and spiritual beliefs
D) Behaviors and skills necessary to carry out a community social assessment
ANS: B
Feedback: Leininger's theory identifies the relationships between cultural variables and
health and highlights the nursing behaviors and skills necessary to carry out effective
cultural assessment. None of the other options accurately describe Leininger's theory.

PTS: 1
REF: Page: 217 | Header: Leininger's Cultural Care Diversity and Universality
Theory/Model OBJ: 1
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

14. The nurse is caring for a hospitalized client from a culture that believes that a diet low in
fruit and vegetables and high in fat is healthiest. While writing the plan of care for this
client, it would be important to include which of the following nursing diagnoses?
A) Emotional distress related to hospital diet
B) Spiritual distress related to prescribed diet
C) Nutritional deficiency related to beliefs in societal diet
D) Nutritional excess related to societal diet
ANS: A
Feedback: In many cultures, ideal body weight is higher than medical experts
recommend. Such cultures may not consider “dieting” healthy. People may prefer to
consume foods high in fat, salt, and cholesterol and low in fruit and vegetables because
they believe that it is best for their health. The most appropriate nursing diagnosis in this
case involves the emotional distress the client will likely experience following the
hospital diet. Regardless of the client's potential beliefs, the hospital diet would not pose
a risk for a nutritional deficiency. While the client's diet may be excessive in certain
nutrients, the nurse or a dietician would have to do more extensive nutritional assessment
to arrive at specific conclusions.

PTS: 1 REF: Page: 223 | Header: Cultural Food and Nutrition Practices
OBJ: 3 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

15. When performing a systematic community assessment, a nurse chooses to use


Kretzmann and McKnight's framework. What intervention demonstrates the nurse's
understanding of this particular framework?
A) Forming a partner assessment
B) Generating a holistic picture
C) Asset mapping
D) Core element diagramming
ANS: C
Feedback: An example of a systematic community assessment framework is Kretzmann
and McKnight's “asset mapping.” None of the other options are associated with this
framework.

PTS: 1 REF: Page: 229 | Header: Social Assessment of the Community


OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

16. The nurse can best practice effective care by exhibiting which behavior during a cultural
assessment?
A) Set a focused time limit for collecting data.
B) Stay focused on the computer screen to remain neutral.
C) De-emphasize nonverbal communication cues.
D) Acknowledge own prejudices that might create barriers to care.
ANS: D
Feedback: Acknowledgment that the nurse's own beliefs and prejudices might create
barriers to providing culturally sensitive care. Leininger suggests that the attributes and
behaviors of a nurse practicing effective care within the patient's cultural context include
the following: genuine interest in a patient's culture and personal life experiences; active
listening and awareness of meanings behind the patient's verbal communication
(storytelling); Nonverbal communication (body language, eye contact, facial
expressions, interpersonal space, and preferences regarding touch).

PTS: 1
REF: Page: 217 | Header: Leininger's Cultural Care Diversity and Universality
Theory/Model OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Caring BLM: Cognitive Level: Understand

17. The nurse is in the client's room after she has given birth one day ago and observes a
family member offering the baby a bottle after the infant has breastfed. The family
member states to the new mother, "This baby is not fat enough and needs to eat double
the first few weeks." What is the nurse's best action?
A) Offer the client formula and bottles to keep at bedside when needed.
B) Provide information to the client and family about newborn nutritional needs.
C) Reassure the mother that the baby will gain more weight with bottle feeding.
D) Remind the mother to decrease her caloric intake while increasing the baby's.
ANS: B
Feedback: Culturally based postpartum practices are diverse. Generally, most cultures
believe that a fat baby is a healthy baby, and new parents might be advised to offer their
baby a bottle after breastfeeding to ensure that the infant is not starving and puts some
meat on the bones fast. In these situations, the nurse must provide facts about infants’
nutritional needs and weight-gain patterns, as well as health risks associated with infant
formula consumption and overfeeding. None of the other options provide information or
interventions that are accurate and effective in assuring healthy infant nutrition.

PTS: 1
REF: Page: 223 | Header: Cultural Beliefs and Practices of Pregnancy and Childbirth
OBJ: 3
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply

18. What nursing intervention is required when delivering effective nursing care to a stoic
client regarding pain management?
A) Reinforce the need to use a pain rating tool to help manage pain
B) Frequently observe for nonverbal cues that the client is in pain
C) Monitor the client closely for pain medication related side effects
D) Educate the client thoroughly to the signs of pain medication abuse
ANS: A
Feedback: You must rely both on patients' verbal and nonverbal manifestations when
assessing and treating pain in a cultural context. Stoic patients may be less likely to
openly express their pain verbally and nonverbally and may prefer to be left alone to
bear their pain and suffering. Studies have found stoic pain behavior is more often found
to contribute to a high pain tolerance or complete refusal of pain medication.

PTS: 1 REF: Page: 224 | Header: Cultural Beliefs and Expressions of


Pain
OBJ: 2|3 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter: 10 KEY: Integrated Process: Physiological Integrity
BLM: Cognitive Level: Apply
19. What nurse focused characteristic cited by Purnell's Model of Transcultural Health Care
is fundamental to the ability to provide culturally competent care?
A) Understanding different cultures first requires understanding oneself
B) Viewing the patient as an equal partner in the assessment of needs
C) Implementing a systematic cultural assessment is its primary focus
D) Possessing a cultural desire to be culturally competent
ANS: A
Feedback: The process involves reflecting on your own personal development as it has
been influenced by gender, race, ethnicity, religion, education, and socioeconomic status.
As you understand yourself, you progress to learning about other cultures. The specific
aim of Leininger's Cultural Care Diversity and Universality Theory/Model encourages a
cultural assessment to provide an all-inclusive picture of the patient's culture-based
health care needs. Campinha-Bacote's Model of Cultural Competence includes the need
to possess a cultural desire (the process of wanting to be culturally competent). Giger
and Davidhizar's Model of Transcultural Nursing encourages flexibility and the
involvement of the patient as an equal partner in the cultural assessment of needs.

PTS: 1
REF: Page: 218 | Header: Purnell's Model of Transcultural Health Care
OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand

20. Selection of which topic for a community education session at a local college reflects the
presenting nurse's understanding of current topics related to social history assessment?
A) Causes of long-term stress
B) Identifying unhealthy behaviors
C) Effect of life experiences on health
D) Recognizing signs of domestic violence
ANS: D
Feedback: Common current topics include information related to victims of domestic
violence. All other options are among newly proposed new topics for such an
assessment.

PTS: 1
REF: Page: 229 | Header: Box 10.4 Common Current Topics and Proposed
Comprehensive Topics for the Patient Social History OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

21. During an assessment interview, a client shares that, “I seldom spend time socializing”.
What question should the nurse ask to best determine if the client is demonstrating social
isolation?
A) “Do you consider yourself to be socially isolated?”
B) “Why do you avoid spending time with other people?”
C) “Can you tell me about what its lead to such a lonely life?”
D) “Would you like to be more involved with family and friends?”
ANS: D
Feedback: It is initially appropriate to determine if the client views this situation as a
negative state of loneliness or as a personal preference. It is best to avoid “why
“questions since they are often viewed as being threatening by the client. The remaining
options make assumptions concerning the client self-perception of being lonely or
socially isolated.

PTS: 1
REF: Page: 232 | Header: Table 10.2 Common Nursing Diagnoses Associated With
Social and Spiritual Domains OBJ: 6
NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 10
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

22. What assessment question is best designed to initiate a conversation with a client about
cultural heath care practices regarding the management of hypertension?
A) “How has being diagnosed with hypertension affected your life?”
B) “What do you do regularly to take control of your hypertension?”
C) “What antihypertensive medication are you currently taking?”
D) “When were you initially diagnosed with hypertension?”
ANS: B
Feedback: Seeking an understanding of patients' culturally based health care practices is
essential to nursing because each culture has its own traditional values and beliefs about
health and illness that may affect individuals' following treatment recommendations.
While each of the remaining options suggest appropriate assessment questions, none is
as directly focused on initiating a conversation related to the client's health care practices
as asking what those practices are.

PTS: 1
REF: Page: 223 | Header: Cultural Health Beliefs and Practices—Safety Alert
OBJ: 3 NAT: Client Needs: Physiological Integrity
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

23. Which question asked during a pre-surgical assessment interview demonstrates an


understanding of the principal standard proposed by the National Standards for
Culturally and Linguistically Appropriate Services in Health Care (CLAS)?
A) “In what language would you prefer your pre-surgical instructions to be written
in?”
B) “Will you need in-home care services when you are discharged?”
C) “Is there a family member available to translate for you now?”
D) “How many languages are you conversant in?”
ANS: A
Feedback: The National CLAS Standards are intended to advance health equity, improve
quality, and help eliminate health care disparities by establishing a blueprint for health
and health care organizations to provide effective, equitable, understandable, and
respectful quality care and services that are responsive to diverse cultural health beliefs
and practices, preferred languages, health literacy, and other communication needs.
While the other options provide appropriate information, none addresses the aim of
CLAS as does identifying the client's preferred language.

PTS: 1
REF: Page: 216 | Header: Box 10.1 National Standards for Culturally and
Linguistically Appropriate Services in Health Care (CLAS) OBJ: 3
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 10
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply

24. Which nursing intervention will best address the client's acknowledgment of being
“lonely” since moving to a rural community from a large city?
A) Arranging for a family meeting to discuss the client's concerns
B) Asking, “What is it about moving that makes you feel isolated?”
C) Assessing the client for other manifestations of possible depression
D) Acknowledging that making such a major life change can be traumatic
ANS: B
Feedback: Social isolation, such after a major life change, can result in a sense of
loneliness and is often viewed as a negative condition. Discussing possible causes of the
isolation is the initial step in formulating a plan of care to manage the emotion and the
possibility of comorbid depression. The value of the other options is not possible until an
assessment of cause is completed.

PTS: 1
REF: Page: 232 | Header: Table 10.2 Common Nursing Diagnoses Associated With
Social and Spiritual Domains OBJ: 5
NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 10
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

25. Where does an individual first begin to form his/her personal cultural values?
A) In utero, when genetics form a basis of personality
B) From family or others acting as primary care providers
C) In the school environment, where we are exposed to various cultures
D) From the community where we grow into self-sufficient, autonomous adults
ANS: B
Feedback: Culture is defined as the totality of socially transmitted behavioral patterns,
beliefs, values, customs, lifeways, arts, and other products of human work and thought
characteristics of a population of people that guide their worldview and decision-making
Culture is learned first in the family, and then school, community, and other social
exposures add to the individual's culture.

PTS: 1 REF: Page: 217 | Header: Characteristics of Culture


OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

26. What response should the nurse make to best support a client who states, “I'm ready to
accept my impeding death”?
A) “Is there anyone you'd like to talk with about your feelings?”
B) “Let me know if there is anything I can do to help you.”
C) “What gave you the strength to make this decision?”
D) “I'm so very happy for you; you've found peace.”
ANS: A
Feedback: The client is expressing “Readiness for enhanced spiritual well-being” and the
nurse should make referrals when indicated and promote support from friends and
family. While the offer to help is appropriate, it does not provide the client with direct
support. Asking about how the client arrived at the decision to accept their death does
not provide support nor does affirming their decision.

PTS: 1
REF: Page: 232 | Header: Table 10.2 Common Nursing Diagnoses Associated With
Social and Spiritual Domains OBJ: 5
NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 10
KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

27. How can a nurse best prepare to provide clients with effective, culturally competent
care?
A) Study the cultural beliefs and values of the diverse populations in his/her care
B) Identify personal biases that create barriers to an effective nurse-client relation
C) Become proficient at conducting effective cultural assessments
D) Embrace the values of the populations regularly cared for
ANS: B
Feedback: Acknowledgment that the nurse's own beliefs and prejudices might create
barriers to providing culturally sensitive care is critical to the ability to provide effective
care. While understanding cultural beliefs and values and preforming an effective
cultural assessment is critical, neither is likely to occur if personal biases are not first
addressed. One does not have to embrace divergent cultural values but rather respect
them.

PTS: 1
REF: Page: 217 | Header: Leininger's Cultural Care Diversity and Universality
Theory/Model OBJ: 3
NAT: Client Needs: Safe, Effective Care Environment TOP: Chapter: 10
KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

MULTIPLE RESPONSE
28. The nurse is participating in a group discussion related to performing a social assessment
on diverse populations. What topic would be important to include in this assessment?
Select all that apply.
A) Societal trends
B) Spiritual architecture
C) Individuals in the society
D) Occupational relationships
E) Social relationships
ANS: A, E
Feedback: At the societal level, social assessments intended to generate information
about societal trends and relationships among the social variables and prevalent health
concerns. The other options are incorrect because an assessment of a society does not
include spiritual architecture, the individuals in the society, or their occupational
relationships.

PTS: 1 REF: Page: 231 | Header: Social Assessment at the Societal


Level
OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand

29. Which question should the nurse include to effectively address the goals of a health care
practice assessment? Select all that apply.
A) “Is health care a right or a privilege ?”
B) “Are you adverse to blood transfusions?”
C) “Should health care be an individual choice?”
D) “Would you consider an organ transplant if needed?"
E) “What are your beliefs about drug abuse rehabilitation?”
ANS: B, D, E
Feedback: Seeking understanding of patients' culturally based health care practices is
essential to nursing because each culture has its own traditional values and beliefs about
health and illness. These values and beliefs play a central role in a client's adherence to
prescribed treatments. Inquiring about blood transfusions, organ transplantation, and
drug rehabilitation have direct bearing on personal treatment modalities. All remaining
options are associated with values related to the delivery of healthcare in general.

PTS: 1
REF: Page: 223 | Header: Cultural Health Beliefs and Practices—Safety Alert
OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply

30. Which assessment question focuses on a secondary characteristic of culture as identified


by Purnell's Model of Transcultural Health Care. Select all that apply/
A) “Mr. Ford, what is your birthdate?”
B) “Mr. Ford, are you a registered voter?”
C) “Mrs. Horvath, what is your family nationality?”
D) “Mr. Ford, what did you do for a living prior to retirement?”
Test Bank for Nursing Health Assessment A Best Practice Approach, Sharon Jensen, ISBN-10: 07

E) “Mrs. Horvath, when did you become an American citizen?”


ANS: D, E
Feedback: Secondary characteristics include cultural values, religious beliefs, morals,
occupation, socioeconomic status, immigration status, reasons for migration, and beliefs
about health held as important to life and healthy living. Primary characteristics include
age, gender, nationality, and ethnicity. A question about voting habits is not related to
the model and has minimal impact on health practices.

PTS: 1
REF: Page: 218 | Header: Purnell's Model of Transcultural Health Care
OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter: 10 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand

Visit TestBankBell.com to get complete for all chapters


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The Project Gutenberg eBook of Sea curse
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Title: Sea curse

Author: Robert E. Howard

Release date: January 13, 2024 [eBook #72707]

Language: English

Original publication: New York: Weird Tales, 1928

Credits: Al Haines

*** START OF THE PROJECT GUTENBERG EBOOK SEA CURSE


***
Sea Curse
ROBERT E. HOWARD

ACKNOWLEDGMENTS

Sea Curse, copyright 1928 by Popular Fiction Publishing Company for


Weird Tales, May 1928.

Sea Curse

And some return by the failing light


And some in the waking dream,
For she hears the heels of the dripping ghosts
That ride the rough roofbeam.
—Kipling
They were the brawlers and braggarts, the loud boasters and hard
drinkers, of Faring town, John Kulrek and his crony Lie-lip Canool. Many a
time have I, a tousled-haired lad, stolen to the tavern door to listen to their
curses, their profane arguments and wild sea songs; half fearful and half in
admiration of these wild rovers. Aye, all the people of Faring town gazed on
them with fear and admiration, for they were not like the rest of the Faring
men; they were not content to ply their trade along the coasts and among
the shark-teeth shoals. No yawls, no skiffs for them! They fared far, farther
than any other man in the village, for they shipped on the great sailing-ships
that went out on the white tides to brave the restless gray ocean and make
ports in strange lands.

Ah, I mind it was swift times in the little sea-coast village of Faring
when John Kulrek came home, with his furtive Lie-lip at his side,
swaggering down the gang-plank, in his tarry sea-clothes, and the broad
leather belt that held his ever-ready dagger; shouting condescending
greeting to some favored acquaintance, kissing some maiden who ventured
too near; then up the street, roaring some scarcely decent song of the sea.
How the cringers and the idlers, the hangers-on, would swarm about the
two desperate heroes, flattering and smirking, guffawing hilariously at each
nasty jest. For to the tavern loafers and to some of the weaker among the
straight-forward villagers, these men with their wild talk and their brutal
deeds, their tales of the Seven Seas and the far countries, these men, I say,
were valiant knights, nature's noblemen who dared to be men of blood and
brawn.

And all feared them, so that when a man was beaten or a woman
insulted, the villagers muttered—and did nothing. And so when Moll
Farrell's niece was put to shame by John Kulrek, none dared even to put in
words what all thought. Moll had never married, and she and the girl lived
alone in a little hut down close to the beach, so close that in high tide the
waves came almost to the door.

The people of the village accounted old Moll something of a witch, and
she was a grim, gaunt old dame who had little to say to anyone. But she
minded her own business, and eked out a slim living by gathering clams,
and picking up bits of driftwood.
The girl was a pretty, foolish little thing, vain and easily befooled, else
she had never yielded to the shark-like blandishments of John Kulrek.

I mind the day was a cold winter day with a sharp breeze out of the east
when the old dame came into the village street shrieking that the girl had
vanished. All scattered over the beach and back among the bleak inland
hills to search for her—all save John Kulrek and his cronies who sat in the
tavern dicing and toping. All the while beyond the shoals, we heard the
never-ceasing droning of the heaving, restless grey monster, and in the dim
light of the ghostly dawn Moll Farrell's girl came home.

The tides bore her gently across the wet sands and laid her almost at her
own door. Virgin-white she was, and her arms were folded across her still
bosom; calm was her face, and the gray tides sighed about her slender
limbs. Moll Farrell's eyes were stones, yet she stood above her dead girl and
spoke no word till John Kulrek and his crony came reeling down from the
tavern, their drinking-jacks still in their hands. Drunk was John Kulrek, and
the people gave back for him, murder in their souls; so he came and laughed
at Moll Farrell across the body of her girl.

"Zounds!" swore John Kulrek; "the wench has drowned herself, Lie-lip!"

Lie-lip laughed, with the twist of his thin mouth. He always hated Moll
Farrell, for it was she that had given him the name of Lie-lip.

Then John Kulrek lifted his drinking-jack, swaying on his uncertain legs.
"A health to the wench's ghost!" he bellowed, while all stood aghast.

Then Moll Farrell spoke, and the words broke from her in a scream
which sent ripples of cold up and down the spines of the throng.

"The curse of the Foul Fiend upon you, John Kulrek!" she screamed.
"The curse of God rest upon your vile soul throughout eternity! May you
gaze on sights that shall sear the eyes of you and scorch the soul of you!
May you die a bloody death and writhe in hell's flames for a million and a
million and yet a million years! I curse you by sea and by land, by earth and
by air, by the demons of the oceans and the demons of the swamplands, the
fiends of the forests and the goblins of the hills! And you—" her lean finger
stabbed at Lie-lip Canool and he started backward, his face paling, "you
shall be the death of John Kulrek and he shall be the death of you! You shall
bring John Kulrek to the doors of hell and John Kulrek shall bring you to
the gallows-tree! I set the seal of death upon your brow, John Kulrek! You
shall live in terror and die in horror far out upon the cold grey sea! But the
sea that took the soul of innocence to her bosom shall not take you, but
shall fling forth your vile carcass to the sands! Aye, John Kulrek—" and she
spoke with such a terrible intensity that the drunken mockery on the man's
face changed to one of swinish stupidity, "the sea roars for the victim it will
not keep! There is snow upon the hills, John Kulrek, and ere it melts your
corpse will lie at my feet. And I shall spit upon it and be content."

Kulrek and his crony sailed at dawn for a long voyage, and Moll went
back to her hut and her clam gathering. She seemed to grow leaner and
more grim than ever and her eyes smoldered with a light not sane. The days
glided by and people whispered among themselves that Moll's days were
numbered, for she faded to a ghost of a woman; but she went her way,
refusing all aid.

That was a short, cold summer and the snow on the barren inland hills
never melted; a thing very unusual, which caused much comment among
the villagers. At dusk and at dawn Moll would come up on the beach, gaze
up at the snow which glittered on the hills, then out to sea with a fierce
intensity in her gaze.

Then the days grew shorter, the nights longer and darker, and the cold
grey tides came sweeping along the bleak strands, bearing the rain and sleet
of the sharp east breezes.

And upon a bleak day a trading-vessel sailed into the bay and anchored.
And all the idlers and the wastrels flocked to the wharfs, for that was the
ship upon which John Kulrek and Lie-lip Canool had sailed. Down the
gang-plank came Lie-lip, more furtive than ever, but John Kulrek was not
there.

To shouted queries, Canool shook his head. "Kulrek deserted ship at a


port of Sumatra," said he. "He had a row with the skipper, lads; wanted me
to desert, too, but no! I had to see you fine lads again, eh, boys?"
Almost cringing was Lie-lip Canool, and suddenly he recoiled as Moll
Farrell came through the throng. A moment they stood eyeing each other;
then Moll's grim lips bent in a terrible smile.

"There's blood on your hand, Canool!" she lashed out suddenly—so


suddenly that Lie-lip started and rubbed his right hand across his left sleeve.

"Stand aside, witch!" he snarled in sudden anger, striding through the


crowd which gave back for him. His admirers followed him to the tavern.

Now, I mind that the next day was even colder; grey fogs came drifting
out of the east and veiled the sea and the beaches. There would be no
sailing that day, and so all the villagers were in their snug houses or
matching tales at the tavern. So it came about that Joe, my friend, a lad of
my own age, and I, were the ones who saw the first of the strange thing that
happened.

Being harum-scarum lads of no wisdom, we were sitting in a small


rowboat, floating at the end of the wharfs, each shivering and wishing the
other would suggest leaving, there being no reason whatever for our being
there, save that it was a good place to build air-castles undisturbed.

Suddenly Joe raised his hand. "Say," he said, "d'ye hear? Who can be out
on the bay upon a day like this?"

"Nobody. What d'ye hear?"

"Oars. Or I'm a lubber. Listen."

There was no seeing anything in that fog, and I heard nothing. Yet Joe
swore he did, and suddenly his face assumed a strange look.

"Somebody rowing out there, I tell you! The bay is alive with oars from
the sound! A score of boats at the least! Ye dolt, can ye not hear?"

Then, as I shook my head, he leaped and began to undo the painter.

"I'm off to see. Name me liar if the bay is not full of boats, all together
like a close fleet. Are you with me?"
Yes, I was with him, though I heard nothing. Then out in the greyness we
went, and the fog closed behind and before so that we drifted in a vague
world of smoke, seeing naught and hearing naught. We were lost in no time,
and I cursed Joe for leading us upon a wild goose chase that was like to end
with our being swept out to sea. I thought of Moll Farrell's girl and
shuddered.

How long we drifted I know not. Minutes faded into hours, hours into
centuries. Still Joe swore he heard the oars, now close at hand, now far
away, and for hours we followed them, steering our course toward the
sound, as the noise grew or receded. This I later thought of, and could not
understand.

Then, when my hands were so numb that I could no longer hold the oar,
and the forerunning drowsiness of cold and exhaustion was stealing over
me, bleak white stars broke through the fog which glided suddenly away,
fading like a ghost of smoke, and we found ourselves afloat just outside the
mouth of the bay. The waters lay smooth as a pond, all dark green and silver
in the starlight, and the cold came crisper than ever. I was swinging the boat
about, to put back into the bay, when Joe gave a shout, and for the first time
I heard the clack of oar-locks. I glanced over my shoulder and my blood
went cold.

A great beaked prow loomed above us, a weird, unfamiliar shape against
the stars, and as I caught my breath, sheered sharply and swept by us, with a
curious swishing I never heard any other craft make. Joe screamed and
backed oars frantically, and the boat walled out of the way just in time; for
though the prow had missed us, still otherwise we had died. For from the
sides of the ship stood long oars, bank upon bank which swept her along.
Though I had never seen such a craft, I knew her for a galley. But what was
she doing upon our coasts? They said, the far-farers, that such ships were
still in use among the heathens of Barbary; but it was many a long, heaving
mile to Barbary, and even so she did not resemble the ships described by
those who had sailed far.

We started in pursuit, and this was strange, for though the waters broke
about her prow, and she seemed fairly to fly through the waves, yet she was
making little speed, and it was no time before we caught up with her.
Making our painter fast to a chain far back beyond the reach of the swishing
oars, we hailed those on deck. But there came no answer, and at last,
conquering our fears, we clambered up the chain and found ourselves upon
the strangest deck man has trod for many a long, roaring century.

"This is no Barbary rover!" muttered Joe fearsomely. "Look, how old it


seems! Almost ready to fall to pieces. Why, 'tis fairly rotten!"

There was no one on deck, no one at the long sweep with which the craft
was steered. We stole to the hold and looked down the stair. Then and there,
if ever men were on the verge of insanity, it was we. For there were rowers
there, it is true; they sat upon the rowers' benches and drove the creaking
oars through the gray waters. And they that rowed were skeletons!

Shrieking, we plunged across the deck, to fling ourselves into the sea.
But at the rail I tripped upon something and fell headlong, and as I lay, I
saw a thing which vanquished my fear of the horrors below for an instant.
The thing upon which I had tripped was a human body, and in the dim gray
light that was beginning to steal across the eastern waves I saw a dagger hilt
standing up between his shoulders. Joe was at the rail, urging me to haste,
and together we slid down the chain and cut the painter.

Then we stood off into the bay. Straight on kept the grim galley, and we
followed, slowly, wondering. She seemed to be heading straight for the
beach beside the wharfs, and as we approached, we saw the wharfs
thronged with people. They had missed us, no doubt, and now they stood,
there in the early dawn light, struck dumb by the apparition which had
come up out of the night and the grim ocean.

Straight on swept the galley, her oars a-swish; then ere she reached the
shallow water—crash!—a terrific reverberation shook the bay. Before our
eyes the grim craft seemed to melt away; then she vanished, and the green
waters seethed where she had ridden, but there floated no driftwood there,
nor did there ever float any ashore. Aye, something floated ashore, but it
was grim driftwood!

We made the landing amid a hum of excited conversation that stopped


suddenly. Moll Farrell stood before her hut, limned gauntly against the
ghostly dawn, her lean hand pointing seaward. And across the sighing wet
sands, borne by the grey tide, something came floating; something that the
waves dropped at Moll Farrell's feet. And there looked up at us, as we
crowded about, a pair of unseeing eyes set in a still, white face. John Kulrek
had come home.

Still and grim he lay, rocked by the tide, and as he lurched sideways, all
saw the dagger hilt that stood from his back—the dagger all of us had seen
a thousand times at the belt of Lie-lip Canool.

"Aye, I killed him!" came Canool's shriek, as he writhed and groveled


before our gaze. "At sea on a still night in a drunken brawl I slew him and
hurled him overboard! And from the far seas he has followed me—" his
voice sank to a hideous whisper, "because—of—the—curse—the—sea—
would—not—keep—his—body!"

And the wretch sank down, trembling, the shadow of the gallows already
in his eyes.

"Aye!" Strong, deep and exultant was Moll Farrell's voice. "From the
hell of lost craft Satan sent a ship of bygone ages! A ship red with gore and
stained with the memory of horrid crimes! None other would bear such a
vile carcass! The sea has taken vengeance and has given me mine. See now,
how I spit upon the face of John Kulrek."

And with a ghastly laugh, she pitched forward, the blood starting to her
lips. And the sun came up across the restless sea.
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