RNSG 1309: Exam 3 (9, 15-21, 24, 26)
9 – Cultural Awareness
1. A nurse is working at a health fair screening people for liver cancer. Which population group should the nurse monitor most
closely for liver cancer?
a.Hispanic
b.Asian Americans
c.Non-Hispanic Caucasians
d.Non-Hispanic African-Americans
Answer: b. Asian Americans
Rationale: While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian population, they also have
the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic
African-Americans.
2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this
patient?
a.There is a decreased frequency of morbidity.
b.There is an increased incidence of disease.
c.There is an increased level of health.
d.There is a decreased mortality rate.
Answer: b. There is an increased incidence of disease.
Rationale: Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or
increased morbidity and mortality when compared with the general population. Although Americans' health overall has
improved during the past few decades, the health of members of marginalized groups has actually declined.
3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring?
a.Accessibility of health care services
b.Outcomes of health conditions
c.Prevalence of complications
d.Incidence of diseases
Answer: a. Accessibility of health care services
Rationale: While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health
conditions, diseases and related complications, health care disparities are differences among populations in the availability,
accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed
at prevention, treatment, and management of diseases and their complications.
4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence?
a.Communicates effectively in a multicultural context
b.Functions effectively in a multicultural context
c.Visits a foreign country
d.Speaks a different language
Answer: b. Functions effectively in a multicultural context
Rationale: Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively
function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic
competence. Visiting a foreign country does not indicate cultural competence.
,5. The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to
achieve meaningful and supportive care. Which concept is the nurse demonstrating?
a.Marginalized groups
b.Health care disparity
c.Transcultural nursing
d.Culturally congruent care
Answer: d. Culturally congruent care
Rationale: The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life
patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations
left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of
health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment,
and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to
understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular
groups).
6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the
nurse take first?
a.Assessing own biases and attitude
b.Learning about the world view of others
c.Understanding organizational forces
d.Developing cultural skills
Answer: a. Assessing own biases and attitude
Rationale: Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-
centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of
learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding
organizational forces are not the first steps.
7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication. Which area will the nurse assess
for the "H"?
a.Health
b.Healers
c.History
d.Homeland
Answer: b. Healers
Rationale: The "H" in ETHNIC stands for healers: Has the patient sought advice from alternative health practitioners? While
health, history, and homeland are important, they are not components of "H."
8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which
action should the nurse take?
a.Use long sentences when talking.
b.Look at the patient when talking.
c.Use breaks in sentences when talking.
d.Look at only nonverbal behaviors when talking.
Answer: b. Look at the patient when talking.
Rationale: Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by
using short sentences, but do not break your sentences. Observe the patient's nonverbal and verbal behaviors.
9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients?
a.Provides care to transgender patients
b.Provides care to restore relationships
c.Provides care to patients that is individualized
d.Provides care to surgical patients
,Answer: a. Provides care to transgender patients
Rationale: Although cultural competence and patient-centered care both aim to improve health care quality, their focus is
slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and
fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care,
rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims
to elevate quality for all patients.
10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the nurse indicates successful
implementation of this technique?
a.Asks, "Does this make sense?"
b.Asks, "Do you think you can do this at home?"
c.Asks, "What will you tell your spouse about changing the dressing?"
d.Asks, "Would you tell me if you don't understand something so we can go over it?"
Answer: c. Asks, "What will you tell your spouse about changing the dressing?"
Rationale: The Teach-Back technique asks open-ended questions, like what will you tell your spouse about changing the
dressing, to verify a patient's understanding. When using the Teach-Back technique do not ask a patient, "Do you understand?"
or "Do you have any questions?" Does this make sense and do you think you can do this at home are closed-ended questions.
Would you tell me if you don't understand something so we can go over it is not verifying a patient's understanding about the
teaching.
11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most
improvement in core measures?
a.Caucasians
b.Poor people
c.Alaska Natives
d.American Indians
Answer: b. Poor people
Rationale: To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-
income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for
about 30% of core measures.
12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use?
a.Use partnered rather than married.
b.Use mother rather than father.
c.Use parents rather than guardian.
d.Use wife/husband rather than significant other.
Answer: a. Use partnered rather than married.
Rationale: Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice
impacted by many factors. For example, provide options such as "partnered" under relationship status. For parents, use
parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or
significant other), listening and reflecting patient's choice. Remember that some LGBT patients are also legally married.
13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse
monitor most closely?
a.Young bisexuals
b.Young caucasians
c.Asian Americans
d.African-Americans
Answer: a. Young bisexuals
Rationale: Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts,
and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical
attention. Caucasian youth, Asian Americans, and African-Americans are not as likely to attempt suicide resulting in medical
attention.
, 14. A nurse is assessing a patient's ethnohistory. Which question should the nurse ask?
a.What language do you speak at home?
b.How different is your life here from back home?
c.Which caregivers do you seek when you are sick?
d.How different is what we do from what your family does when you are sick?
Answer: b. How different is your life here from back home?
Rationale: An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice
questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what
your family does when you are sick? The language and communication is the following: What language do you speak at home?
15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy?
a.A patient 35 years old
b.A patient 68 years old
c.A patient with a college degree
d.A patient with a high-school diploma
Answer: b. A patient 68 years old
Rationale: About 9 out of 10 people in the United States experience challenges in using health care information. Patients who
are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-
school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients
with high-school and college education are not identified in the vulnerable populations.
16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using?
a.Document staff satisfaction.
b.Focus on the family.
c.Implement change on a grand scale.
d.Reduce disparities.
Answer: d. Reduced disparities.
Rationale: Organizations can implement equity-focused quality improvement by recognizing disparities and committing to
reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is
important, the focus is on the patients. Organizations should start by implementing a change on a small scale (pilot testing),
learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act).
17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of
providing culturally congruent care?
a.Provides care that fits the patient's valued life patterns and set of meanings
b.Provides care that is based on meanings generated by predetermined criteria
c.Provides care that makes the nurse the leader in determining what is needed
d.Provides care that is the same as the values of the professional health care system
Answer: a. Provides care that fits the patient's valued life patterns and set of meanings
Rationale: The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns,
values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined
criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to
assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is
needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and
meanings of the professional health care system.
18. A nurse is assessing the patient's meaning of illness. Which area of focus by the nurse is priority?
a.On the way a patient reacts to disease
9 – Cultural Awareness
1. A nurse is working at a health fair screening people for liver cancer. Which population group should the nurse monitor most
closely for liver cancer?
a.Hispanic
b.Asian Americans
c.Non-Hispanic Caucasians
d.Non-Hispanic African-Americans
Answer: b. Asian Americans
Rationale: While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian population, they also have
the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic
African-Americans.
2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this
patient?
a.There is a decreased frequency of morbidity.
b.There is an increased incidence of disease.
c.There is an increased level of health.
d.There is a decreased mortality rate.
Answer: b. There is an increased incidence of disease.
Rationale: Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or
increased morbidity and mortality when compared with the general population. Although Americans' health overall has
improved during the past few decades, the health of members of marginalized groups has actually declined.
3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring?
a.Accessibility of health care services
b.Outcomes of health conditions
c.Prevalence of complications
d.Incidence of diseases
Answer: a. Accessibility of health care services
Rationale: While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health
conditions, diseases and related complications, health care disparities are differences among populations in the availability,
accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed
at prevention, treatment, and management of diseases and their complications.
4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence?
a.Communicates effectively in a multicultural context
b.Functions effectively in a multicultural context
c.Visits a foreign country
d.Speaks a different language
Answer: b. Functions effectively in a multicultural context
Rationale: Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively
function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic
competence. Visiting a foreign country does not indicate cultural competence.
,5. The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to
achieve meaningful and supportive care. Which concept is the nurse demonstrating?
a.Marginalized groups
b.Health care disparity
c.Transcultural nursing
d.Culturally congruent care
Answer: d. Culturally congruent care
Rationale: The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life
patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations
left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of
health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment,
and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to
understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular
groups).
6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the
nurse take first?
a.Assessing own biases and attitude
b.Learning about the world view of others
c.Understanding organizational forces
d.Developing cultural skills
Answer: a. Assessing own biases and attitude
Rationale: Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-
centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of
learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding
organizational forces are not the first steps.
7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication. Which area will the nurse assess
for the "H"?
a.Health
b.Healers
c.History
d.Homeland
Answer: b. Healers
Rationale: The "H" in ETHNIC stands for healers: Has the patient sought advice from alternative health practitioners? While
health, history, and homeland are important, they are not components of "H."
8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which
action should the nurse take?
a.Use long sentences when talking.
b.Look at the patient when talking.
c.Use breaks in sentences when talking.
d.Look at only nonverbal behaviors when talking.
Answer: b. Look at the patient when talking.
Rationale: Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by
using short sentences, but do not break your sentences. Observe the patient's nonverbal and verbal behaviors.
9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients?
a.Provides care to transgender patients
b.Provides care to restore relationships
c.Provides care to patients that is individualized
d.Provides care to surgical patients
,Answer: a. Provides care to transgender patients
Rationale: Although cultural competence and patient-centered care both aim to improve health care quality, their focus is
slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and
fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care,
rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims
to elevate quality for all patients.
10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the nurse indicates successful
implementation of this technique?
a.Asks, "Does this make sense?"
b.Asks, "Do you think you can do this at home?"
c.Asks, "What will you tell your spouse about changing the dressing?"
d.Asks, "Would you tell me if you don't understand something so we can go over it?"
Answer: c. Asks, "What will you tell your spouse about changing the dressing?"
Rationale: The Teach-Back technique asks open-ended questions, like what will you tell your spouse about changing the
dressing, to verify a patient's understanding. When using the Teach-Back technique do not ask a patient, "Do you understand?"
or "Do you have any questions?" Does this make sense and do you think you can do this at home are closed-ended questions.
Would you tell me if you don't understand something so we can go over it is not verifying a patient's understanding about the
teaching.
11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most
improvement in core measures?
a.Caucasians
b.Poor people
c.Alaska Natives
d.American Indians
Answer: b. Poor people
Rationale: To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-
income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for
about 30% of core measures.
12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use?
a.Use partnered rather than married.
b.Use mother rather than father.
c.Use parents rather than guardian.
d.Use wife/husband rather than significant other.
Answer: a. Use partnered rather than married.
Rationale: Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice
impacted by many factors. For example, provide options such as "partnered" under relationship status. For parents, use
parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or
significant other), listening and reflecting patient's choice. Remember that some LGBT patients are also legally married.
13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse
monitor most closely?
a.Young bisexuals
b.Young caucasians
c.Asian Americans
d.African-Americans
Answer: a. Young bisexuals
Rationale: Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts,
and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical
attention. Caucasian youth, Asian Americans, and African-Americans are not as likely to attempt suicide resulting in medical
attention.
, 14. A nurse is assessing a patient's ethnohistory. Which question should the nurse ask?
a.What language do you speak at home?
b.How different is your life here from back home?
c.Which caregivers do you seek when you are sick?
d.How different is what we do from what your family does when you are sick?
Answer: b. How different is your life here from back home?
Rationale: An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice
questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what
your family does when you are sick? The language and communication is the following: What language do you speak at home?
15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy?
a.A patient 35 years old
b.A patient 68 years old
c.A patient with a college degree
d.A patient with a high-school diploma
Answer: b. A patient 68 years old
Rationale: About 9 out of 10 people in the United States experience challenges in using health care information. Patients who
are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-
school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients
with high-school and college education are not identified in the vulnerable populations.
16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using?
a.Document staff satisfaction.
b.Focus on the family.
c.Implement change on a grand scale.
d.Reduce disparities.
Answer: d. Reduced disparities.
Rationale: Organizations can implement equity-focused quality improvement by recognizing disparities and committing to
reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is
important, the focus is on the patients. Organizations should start by implementing a change on a small scale (pilot testing),
learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act).
17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of
providing culturally congruent care?
a.Provides care that fits the patient's valued life patterns and set of meanings
b.Provides care that is based on meanings generated by predetermined criteria
c.Provides care that makes the nurse the leader in determining what is needed
d.Provides care that is the same as the values of the professional health care system
Answer: a. Provides care that fits the patient's valued life patterns and set of meanings
Rationale: The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns,
values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined
criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to
assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is
needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and
meanings of the professional health care system.
18. A nurse is assessing the patient's meaning of illness. Which area of focus by the nurse is priority?
a.On the way a patient reacts to disease
