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Chapter 04: Social, Cultural, and Religious Influences on Child Health Promotion

MULTIPLE CHOICE
1. Which term best describes a group of people who share a set of values, beliefs, practices,

social relationships, law, politics, economics, and norms of behavior?


Race
Culture
Ethnicity
Social group

a.
b.
c.
d.

ANS: B

Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides
the outlook and decisions of a group of people. A culture is composed of individuals who
share a set of values, beliefs, and practices that serve as a frame of reference for individual
perceptions and judgments. Race is defined as a division of mankind possessing traits that are
transmissible by descent and are sufficient to characterize it as a distinct human type.
Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic
heritage. A social group consists of systems of roles carried out in groups. Examples of
primary social groups include the family and peer groups.
PTS: 1
DIF: Cognitive Level: Remember
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 44

2. Which term best describes the emotional attitude that ones own ethnic group is superior to

others?
Culture
Ethnicity
Superiority
Ethnocentrism

a.
b.
c.
d.

ANS: D

Ethnocentrism is the belief that ones way of living and behaving is the best way. This
includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group
are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that
unconsciously frames or guides the outlook and decisions of a group of people. A culture is
composed of individuals who share a set of values, beliefs, and practices that serves as a frame
of reference for individual perception and judgments. Ethnicity is an affiliation of a set of
persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or
quality of being superior; it does not include ethnicity.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 47

3. Currently, the fastest-growing segment of the homeless population in the United States

consists of:
a. families.
b. runaway adolescents.

c. migrant farm workers.


d. individuals with mental disorders.
ANS: A

Homeless individuals lack resources and community ties necessary to provide for their own
adequate shelter. One of the most pressing problems in the United States is the rapidly
growing number of homeless families, which currently account for 50% of the nations
homeless. Runaway (or throwaway) adolescents are often victims of physical and social
abuse. Although it is a significant issue, this is not the fastest-growing segment of the
homeless population. Migrant farm workers form one of the most severely disadvantaged
groups in the United States. They have a mobile existence, which is detrimental for children.
They do not constitute the fastest-growing segment of the homeless population. Individuals
with mental disorders may be homeless. They do not constitute the fastest-growing segment of
the homeless population.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Psychosocial Integrity

REF: 51

4. Maria, a Spanish-speaking 5-year-old girl, has started kindergarten in an English-speaking

school. Crying most of the time, she appears helpless and unable to function in this new
situation. Which description best explains Marias behavior?
a. Lacks adequate culture for attending school
b. Lacks the maturity needed in school
c. Is experiencing culture shock
d. Is experiencing minority group discrimination
ANS: C

Culture shock is the helpless feeling and state of disorientation felt by an outsider attempting
to adapt to a different culture group. Her inability to speak English inhibits her ability to
interact. This would explain Marias inability to function in this new situation. There is no
evidence to support that Maria lacks adequate culture or maturity needed in school, or that she
is experiencing minority group discrimination.
PTS: 1
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 46

5. When minority groups immigrate to another country, a certain degree of cultural or ethnic

blending occurs through the involuntary process of:


acculturation.
ethnocentrism.
culture shock.
cultural sensitivity.

a.
b.
c.
d.

ANS: A

Acculturation is the gradual changes that are produced in a culture by the influence of another
culture that cause one or both cultures to become more similar. The minority culture is forced
to learn the majority culture to survive. Ethnocentrism is the belief that ones way of living
and behaving is the best way. This includes the emotional attitude that the values, beliefs, and
perceptions of ones ethnic group are superior to those of others. This would limit the
blending. Culture shock is the helpless feeling and state of disorientation felt by an outsider
attempting to adapt to a different culture group. This would limit the blending. Cultural
sensitivity is an awareness of cultural similarities and differences. The nurse should develop
the dynamics of cultural sensitivity to provide culturally competent care.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 46

6. Which is a frequent health problem of migrant children and adolescents in the United States?
a. Suicide
b. Diabetes
c. Tuberculosis
d. Cardiovascular disease
ANS: C

The rate of tuberculosis among migrant families is high. A high-risk factor for the children of
migrant families is the migration of the families from areas that have high prevalence of
tuberculosis; significant health issues, suicide, diabetes, and cardiovascular disease are not
more prevalent in this population.
PTS: 1
DIF: Cognitive Level: Understand
REF: 51-52
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
7. The nurse observes that the families who do not show up for scheduled clinic appointments

are usually from minority cultural groups. The best explanation for this is that these families
often differ from the dominant culture because they:
a. lack education.
b. avoid health care.
c. are more forgetful.
d. view time differently.
ANS: D

Each cultural group has different conceptions of time and waiting. The dominant culture in the
United States has a fairly rigid view of time. Other cultures may be late or miss activities
because other issues take precedence over the appointment. Education is not the issue. It is the
concept of time in the cultural group. It is not done to avoid health care. The family usually
believes that the appointment can be made for a later time. The family does not forget the
time, but other issues take priority.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Psychosocial Integrity

REF: 52

8. The Vietnamese mother of a child being seen in the clinic avoids eye contact with the nurse.

The best explanation for this, considering cultural differences, is that the parent:
feels responsible for her childs illness.
feels inferior to the nurse.
is embarrassed to seek health care.
is showing respect for the nurse.

a.
b.
c.
d.

ANS: D

In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may
not look directly into the nurses eyes as a sign of respect. The nurse providing culturally
competent care would recognize that feeling responsible for the illness, feeling inferior, or
embarrassment are not reasons for the mother to avoid eye contact with the nurse.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 54

9. The belief that health is a state of harmony with nature and the universe is common in

which culture?
Japanese
African-American
Native American
Hispanic-American

a.
b.
c.
d.

ANS: C

Many cultures ascribe attributes of health to natural forces. Many individuals of the NativeAmerican culture view health as a state of harmony with nature and the universe. This belief
is not consistent with the Japanese, African-American, or Hispanic-American cultural groups.
PTS: 1
DIF: Cognitive Level: Remember
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 59

10. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the

child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicle,
and juices are left. Which statement would best explain this?
a. Parent is trying to feed child only what child likes most.
b. Parent is trying to restore normal balance through appropriate hot remedies.
c. Hispanics believe the evil eye enters when a person gets cold.
d. Hispanics believe an innate energy, called chi, is strengthened by eating soup.
ANS: B

In several groups, including Filipino, Chinese, Arabic, and Hispanic cultures, hot and cold
describe certain properties completely unrelated to temperature. Respiratory conditions such
as pneumonia are cold conditions and are treated with hot foods. The parent may be
trying to feed the child only what the child likes most, but it is unlikely that a toddler would
consistently prefer the broth to Jell-O, Popsicle, and juice. The evil eye applies to a state of
imbalance of health, not curative actions. Chinese individuals believe in chi as an innate
energy.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Planning

REF: 59

MSC: Area of Client Needs: Psychosocial Integrity


11. A nurse is taking a history on a low-income Hispanic toddler. The parent tells the nurse that

occasional diarrhea is treated with azogue, a mercury compound commonly used in the
parents native Mexico. What should the nurse recognize about this remedy?
a. It is harmless.
b. It is dangerous.
c. It has a scientific basis.
d. It has importance in certain religious practices.
ANS: B

The ingestion of mercury is extremely dangerous for children. Solutions containing mercury
are not harmless. The nurse should work with folk healers or respected members of the culture
to teach the family of the dangers of mercury ingestion. No scientific basis exists for the use
of mercury to treat diarrhea.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Psychosocial Integrity

REF: 56

12. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The

childs mother says she has rubbed the edge of a coin on her childs oiled skin. What
explanation should the nurse recognize about this?
a. Child abuse
b. Cultural practice to rid the body of disease
c. Cultural practice to treat enuresis or temper tantrums
d. Child discipline measure common in the Vietnamese culture
ANS: B

Rubbing the edge of a coin on a childs oiled skin is descriptive of coining. The welts are
created by repeatedly rubbing a coin on the childs oiled skin. The mother is attempting to rid
the childs body of disease. The mother was engaged in an attempt to heal the child. This is
not child abuse or discipline.
PTS: 1
DIF: Cognitive Level: Understand
REF: 56
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Psychosocial Integrity: Cultural Diversity
13. The father of a hospitalized child tells the nurse, He cant have meat. We are Buddhist and

vegetarians. The nurses best intervention is to:


order the child a meatless tray.
ask a Buddhist priest to visit.
explain that hospital patients are exempt from dietary rules.
help the parent understand that meat provides protein needed for healing.

a.
b.
c.
d.

ANS: A

It is essential for the nurse to respect the religious practices of the child and family. The nurse
should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are
prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse
should be able to arrange for a vegetarian tray. The nurse should not encourage the child and
parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian
meals should be provided.

PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Psychosocial Integrity

REF: 61

14. In which cultural group is good health considered to be a balance between yin and yang?
a. Asians
b. Australian aborigines
c. Native Americans
d. African-Americans
ANS: A

In Chinese health beliefs, the forces termed yin and yang must be kept in balance to maintain
health. The belief in this balance is not consistent with Australian aborigines, Native
Americans, or African-Americans.
PTS: 1
DIF: Cognitive Level: Remember
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 58

15. A young child from Mexico is hospitalized for a serious illness. The father tells the nurse that

the child is being punished by God for being bad. The nurse should recognize that this is a(n):
health belief common in this culture.
early indication of potential child abuse.
misunderstanding of the familys common beliefs.
belief common when fortune tellers have been used.

a.
b.
c.
d.

ANS: A

A common health belief in the Mexican-American cultural group is that health is controlled
by the environment, fate, and the will of God. The fathers comment has no relation to child
abuse. The father would not misunderstand the familys beliefs. It is a cultural belief that
health is controlled by the environment, fate, and the will of God. Mexicans may use the
services of curandero (healers), not fortune tellers.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Psychosocial Integrity

REF: 59

MULTIPLE RESPONSE
1. Children are taught the values of their culture through observation and feedback, relative to

their own behavior. In teaching a class on cultural competence, the nurse should be aware that
which factor(s) may be culturally determined? (Select all that apply.)
a. Degree of competition
b. Racial variation
c. Determination of status
d. Social roles
e. Geographic boundaries
ANS: A, C, D

Degree of competition, determination of status, and social roles are all factors that are
determined by the assumptions, beliefs, and practices of the members of the culture. In
cultures that value individual resourcefulness, competition would be acceptable. Status is
culturally determined and varies according to each culture. Some will ascribe higher status to
age or socioeconomic status. Social roles also are influenced by the culture. Race and culture
are two distinct attributes. The racial grouping describes transmissible traits, whereas the
culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously
frames or guides the outlook and decisions of a group of people. Cultural development may be
limited by geographic boundaries. It is not the boundaries that are culturally determined.
PTS: 1
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Psychosocial Integrity

REF: 44

2. Research is being done on the development of assets in children. A community that is

supportive of children has which external assets? (Select all that apply.)
Unstructured environments to allow for freedom of choice
Social competencies to make positive choices
Empowerment to feel safe and secure
Positive values to direct choice
Boundaries to set expectations and actions

a.
b.
c.
d.
e.

ANS: C, E

Young people need to feel valued by their community and able to contribute to others. They
need to feel safe and secure. They also need boundaries to help set expectations and actions.
To develop appropriately, children need boundaries and expectations. With these, they will
learn what is expected of them and what behaviors are acceptable to the community. Social
competencies to make positive choices and boundaries to set expectations and actions are
internal assets that, when developed, help the child make positive choices.
PTS: 1
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 48

3. A nurse is planning care for a Spanish-speaking child and family. The nurse speaks limited

Spanish. Which interventions should the nurse plan when caring for this child and family?
(Select all that apply.)
a. Ask a visitor to interpret.
b. Use a language-line telephone interpreter if a hospital interpreter is not available.
c. Use written cards with common phrases in the Spanish language.
d. Ask the family to provide an interpreter.
e. When using a hospital interpreter, speak to the family not the interpreter.
ANS: B, C, E

If a live interpreter is not available, the nurse should use a language line telephone interpreter.
The nurse should use cards with common greetings, phrases, and names of body parts in the
familys language. When using a hospital interpreter, the nurse should speak directly to the
family and allow the interpreter to translate. Visitors or other family members should not be
used as interpreters because of the risk of misinterpretation of medical terms.
PTS: 1

DIF: Cognitive Level: Apply

REF: 53

TOP: Integrated Process: Nursing Process: Implementation


MSC: Area of Client Needs: Psychosocial Integrity
4. A nurse is working in a clinic that serves a culturally diverse population of children. The nurse

should plan care, understanding that which complementary and alternative practices may be
used by families of this diverse population? (Select all that apply.)
a. Seeking another doctors opinion
b. Seeking advice from a curandero or curandera
c. Using acupuncture or acupressure as a therapy
d. Consulting an herbalist
e. Consulting a kahuna
ANS: B, C, D, E

The curandero (male) or curandera (female) of the Mexican-American community is believed


to have healing powers that are a gift from God. The Asian family may consult an herbalist,
knowledgeable in medicines, or perhaps a specialized practitioner of Asian therapies,
including acupuncture (insertion of needles) or acupressure (application of pressure). Native
Hawaiians consult kahunas and practice hooponopono to heal family imbalance or disputes.
The nurse may encounter use of these practices. Consulting another doctor would not be a
complementary or alternative practice expected in a culturally diverse population.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Psychosocial Integrity

REF: 56

5. A nurse is caring for an African-American child recently admitted to the hospital. The nurse

should be aware of which broad cultural characteristics for this child when planning care?
(Select all that apply.)
a. Silence may indicate a lack of trust.
b. Maintaining constant eye contact may be viewed as aggressive.
c. Self-care and folk medicine do not play a role in healthcare.
d. Illness may be seen as the will of God.
e. No importance is attached to nonverbal behavior.
ANS: A, B, D

A nurse should be aware of the African-American broad cultural characteristics, which


include: initial eye contact to show respect; maintaining eye contact can be viewed as
aggressive, silence may indicate a lack of trust, and illness may be seen as the will of God.
Self-care and folk medicine are prevalent in this culture, and importance is placed on
nonverbal behavior.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Psychosocial Integrity
COMPLETION

REF: 58

1. Poverty has serious implications for children and families. Social and cultural deprivation,

including limited employment opportunities, inferior educational opportunities, inferior or no


access to health care, and a lack of public services, is referred to as the _______________
type of poverty.
ANS:

invisible
Social and cultural deprivation, including limited employment opportunities, inferior
educational opportunities, inferior or no access to health care, and a lack of public services is
the definition of invisible poverty. Visible poverty is the lack of money or material
resources, including insufficient clothing, poor sanitation, and deteriorating housing.
PTS: 1
DIF: Cognitive Level: Remember
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity

REF: 50

2. A parent of a 12-year-old child states to the nurse, My 12-year-old watches TV constantly

while at homeis this OK? The nurse should recommend to the parent that television
viewing should be limited to _____ hours a day? (Record your answer in a whole number.)
ANS:

2
Children may identify closely with people or characters portrayed in reading materials,
movies, and television programs and commercials. Pediatric nurses can educate and support
parents on the effects of mass media on their children by recommending that television
viewing should be limited to 2 hours a day or less.
PTS: 1
DIF: Cognitive Level: Apply
REF: 49
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance