Chapter 02: Emerging Populations and Health
Edelman: Health Promotion Throughout the Life Span, 8th Edition
1. Which of the following statements about ethnic minorities in the United States is accurate?
a. It is estimated that the percentage of ethnic minorities will decrease during the next 30 years.
b. It is estimated that ethnic minorities will increase to one in two by 2050.
c. The increasing population of refugees has been a significant contributor to the increase in ethnic minorities.
d. The increasing population of ethnic minorities has helped decrease the health disparities faced by this population.
It is estimated that the number of ethnic minorities will increase to one in two by 2050. In 2010, it was estimated that 33% of the population was from an ethnic minority. The increasing population of immigrants has been a significant contributor to the increasing populations of major ethnic groups. The increasing populations of ethnic groups is one factor that is producing disparities in health status and access of the health care system.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 24
2. A person states, “My grandmother is the decision maker in our family.” Which of the following is being described by the person?
Culture, as an element of ethnicity, refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. The term “ethnicity” encompasses more than a cultural practice, which is what is being described by the person; it focuses on differences in meanings, values, and ways of living. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Values are beliefs about the worth of something and serve as standards that influence behavior and thinking.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 24
3. The nurse recommended to a 50-year-old woman that she schedule a routine mammogram. Which of the following would be the most important factor in this woman’s decision to schedule this exam?
c. Cultural values
d. Value orientation
Cultural values guide actions and decision-making that facilitates self-worth and self-esteem. They shape human behaviors and determine what individuals will do to maintain their health status, how they will care for themselves, and others who become ill, and where and from whom they will seek health care. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Ethnicity focuses on differences in meanings, values, and ways of living. Value orientations reflect the personality type of a particular society.
DIF: Cognitive Level: Apply (Application) REF: p. 24
4. Which of the following actions demonstrates a health care professional providing culturally competent care?
a. Encouraging the person to take medications as prescribed
b. Asking the person to describe his folk healing methods
c. Demonstrating the proper way to administer an insulin injection
d. Assisting the person with discussing his health problems with the family
It is very important for health care providers to be aware of how people interpret their health issues or illnesses to be capable to provide culturally competent care. A culturally competent health care professional should be able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the patient or client, to respect the person’s values and beliefs, and adjust the approach of delivering care to meet each person’s needs and expectations. Asking the person to describe his folk healing methods is the only action that demonstrates the health care professional seeking input from the person into the care that is received.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 26
5. A person reports that she has been seeking care from an acupuncturist to help relieve the chronic pain that she has been experiencing. Which of the following statements would be the most appropriate response from the nurse?
a. “You should have told me that the current treatments were helping your pain.”
b. “Tell me more about your treatments from the acupuncturist.”
c. “Tell me why you decided to not to continue with your treatment plan.”
d. “You should not be seeing an acupuncturist while receiving professional care.”
Through a culturally sensitive assessment process, nurses can determine what specific remedies individuals are using and whether their continued use would interfere with the prescribed method. The nurse asking the person to describe the treatments from the acupuncturist allows the nurse to learn this information. The other responses demonstrate an ethnocentric perspective by the nurse, viewing the treatments from the acupuncturist as inferior to professional care.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 26
6. When providing an educational session about the Arab American population, which of the following information would be included?
a. The largest group of Arab Americans was refugees in the 1960s.
b. The largest groups of Arab Americans are from Palestine and Iraq.
c. Members of the Arab American population are most likely to live in rural communities.
d. Members of the Arab American population are more likely to have college degrees than Americans at large.
Members of the Arab American population are more likely to have college degrees (+45%) than Americans at large (28%). About 94% of Arab Americans live in metropolitan areas. The largest groups of Arab Americans are the Lebanese, Syrians, and Egyptians. Arab Americans came to the United States in three immigration waves; the last occurred in the 1960s and consisted of many professionals, entrepreneurs, and skilled and semiskilled laborers.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 27
7. A health care professional is caring for an Arab American individual. Which of the following cultural practices of this ethnic minority should be considered when planning care?
a. This ethnic culture tends to be future oriented.
b. Religion plays an important role in this culture.
c. Traditional cultural practices are infrequently used during a health crisis.
d. Members of this culture tend to have smaller families.
Religion plays an important part in Arab culture, and there are dietary rules and prescribed rituals for praying and washing. Arab Americans are present oriented and view the future as uncertain. During a health crisis, many Arab Americans seek out their family, community, and traditional values and cultural practices. Arab American families are, on average, larger than non–Arab American families.
DIF: Cognitive Level: Apply (Application) REF: p. 27
8. A health care professional is providing education to the parents of an Asian American child who has recently been diagnosed with Type I diabetes. Which of the following actions should be taken by the health care professional?
a. Provide instructions to the child’s father.
b. Encourage the parents to bring other siblings into the clinic for screening.
c. Schedule multiple educational sessions for the child and family.
d. Watch for nonverbal gestures by the adults to indicate understanding.
In Asian American culture, the oldest male family member often is the decision maker and spokesperson. Maintaining harmony is an important value in Asian cultures, and it is strongly emphasized to avoid conflict and direct confrontation. As a result of this, Asian Americans may not show their disagreement with the recommendations of health care professionals. Type I diabetes is not a common health problem experienced by this minority, so it is probably not necessary to encourage screening for siblings. Additional educational sessions may be necessary; however, Asian Americans tend to be more highly educated than any other population in the United States.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 29
9. An Asian American family has recently immigrated to the United States. Which of the following would provide an appropriate rationale when encouraging the family to send their child to school?
a. The child will get a good education.
b. According to law, all children must go to school.
c. The child can get health care at school.
d. Exposure to different cultures in school will enhance socialization.
Exposure to different cultures in school facilitates the adoption of other cultural beliefs and aids in the socialization of the child into a new environment.
DIF: Cognitive Level: Apply (Application) REF: p. 29
10. Which of the following was the fastest-growing minority group in the United States between 2000 and 2010?
a. Asian American
b. Arab American
c. Hispanic American
d. Native American
A 43% increase in the Hispanic population between 2000 and 2010 makes Hispanics the fastest-growing minority group in the United States.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 31
11. The interrelationship of poverty and health care dollars spent by Blacks and other minorities is affected greatly by:
a. lack of access to preventive health care services
b. low numbers of minority health care providers
c. use of emergency rooms for care
d. increased infant mortality rates in African American populations
A decrease in resources for preventive care leads to the use of emergency rooms and other more expensive health care services that are often used as resources when severe illness occurs.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 32
12. A health care provider is working with an African American woman who has recently suffered a stroke and is homebound. She insists that she must get out of the house and attend Sunday worship services. What is the most likely explanation for her insisting that she participate in this cultural practice?
a. The church is the only place where prayer can be performed.
b. The church serves as a social support for its members.
c. The church is the place where the family meets on a weekly basis.
d. The church serves as a site for folk healing practices.
The church is significant support system many African Americans. It serves many purposes beyond worship and formation, including serving as a place to meet where members could pass news, take care of business, and find strength of purpose; providing direct social welfare services; acting as a stabilizing force in the community; facilitating citizenship training and community social action; serving as a transmitter of cultural history; and providing the means for coping and surviving in a hostile world. African Americans often find comfort in the support their religious leader can give them, but it does not have to happen within the church. African Americans believe in the healing power of prayer, but that can happen outside of the church as well. Family is the strongest source of support for African Americans, and most meet more often than weekly at church.
DIF: Cognitive Level: Apply (Application) REF: p. 33
13. Which of the following ethnic groups has a disproportionately high death rate from unintentional injuries and suicide?
a. American Indian/Alaska Native Americans
b. Asian Americans
c. Latino/Hispanic Americans
d. Black/African Americans
American Indian/Alaska Native Americans have disproportionately high death rates from unintentional injuries and suicide. Difficult life situations and stresses of daily life contribute to an array of problems, including feelings of hopelessness, desperation, family dissolution, and substance abuse.
DIF: Cognitive Level: Apply (Application) REF: p. 34
14. A health care professional is offering an educational session about providing culturally congruent care. Which of the following information would be included the presentation?
a. Hispanic Americans value keeping balance and harmony with the earth.
b. The oldest male is the decision maker in African American families.
c. Native Americans are present oriented, taking one day at a time.
d. The hot and cold concept of disease is part of the Asian American culture.
Native Americans are generally present oriented, emphasizing events that are occurring now rather than events that will happen later. They take one day at a time and in times of illness they cope by hoping for improvements the next day. Native Americans value keeping balance and harmony with the earth. The oldest male is the decision maker and spokesperson in Asian American families. The hot and cold concept of disease is part of the Hispanic culture.
DIF: Cognitive Level: Apply (Application) REF: p. 34
15. A family has recently become homeless. Which of the following factors most likely contributed to this situation?
a. Being from an ethnic minority background
b. Declining rates of poverty
c. Having multiple chronic illnesses
d. Being unable to find affordable housing
The inability to find affordable housing, decline in public assistance, poverty, and eroding work opportunities all contribute to homelessness. The increasing prevalence of poverty has caused an increase in the homeless population. Other factors that may affect this situation are lack of affordable health care, domestic violence, mental illness, and addiction disorders.
DIF: Cognitive Level: Apply (Application) REF: p. 35
16. A health care professional is caring for an individual who is homeless. Which of the following considerations should be made?
a. The prevalence of substance abuse is much lower among the homeless population than the general population.
b. The prevalence of HIV/AIDS is much lower among the homeless population than the general population.
c. The percentage of the population who has health insurance is much lower among the homeless than the general population.
d. The percentage of the population who has limited access to medical care is much lower among the homeless than the general population.
Most homeless people do not have health insurance or the ability to pay for needed health care, and many providers refuse to deliver treatments to these people. The prevalence of substance abuse, HIV/AIDS, and mental health disorders is higher among the homeless population than the general population.
DIF: Cognitive Level: Apply (Application) REF: p. 36
17. A health care professional is caring for an individual who is homeless and has recently been diagnosed with Type II diabetes. Which of the following factors is the most important to consider when planning care?
a. Considering the cost of the purchasing medications
b. Determining the pharmacy where medications will be obtained
c. Obtaining insurance that will pay for the follow-up care
d. Finding supportive housing for the individual
Research and practice have shown that permanent supportive housing works because housing is an essential part of treatment; thus, this is the most important factor that should be considered. If supportive housing is found, the stability will help the homeless individual to follow the prescribed medical regimen.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 36
18. A health care professional is leading a community action coalition to address the problem of homelessness within the neighborhood. Which of the following statements would most likely be made by health care professional?
a. Homelessness should be addressed by improving financial assistance programs.
b. Homelessness should be of concern to everyone in the neighborhood.
c. Homelessness should be addressed by encouraging job growth in the area.
d. Homelessness should be of concern to the mental health providers in the area.
Homelessness is everyone’s problem, and people can ultimately affect the establishment of priorities to facilitate an improved quality of life. As more people understand homelessness, this will serve as an excellent guide in providing input, taking necessary action, and making the final decision as to what will make a healthy nation.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 37
19. What is the main focus of the National Institutes of Health (NIH)?
a. Addressing and reducing health disparities
b. Outlining nationwide health promotion and disease prevention
c. Protecting minority populations through development of health policies
d. Supporting communities in addressing health disparities
The main concern of the National Institutes of Health is addressing and reducing health disparities involving cancer, diabetes, infant mortality, AIDS, cardiovascular illnesses, and many other diseases. Healthy People 2020 outlines a comprehensive, nationwide health promotion and disease prevention agenda. The Office of Minority Health improves and protects the health of racial and ethnic minority populations through the development of health policies and programs that concentrate on eliminating health disparities. The Centers for Disease Control and Prevention’s Racial and Ethnic Health Disparities Action Institute supports communities to take action in addressing health disparities.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 37
20. A health care professional is searching for a funding source to develop a colorectal cancer screening program for ethnic and racial minorities in the community. Which of the following federal agencies would most likely be able to assist with this initiative?
a. The National Institute on Minority Health and Health Disparities
b. The Centers for Disease Control and Prevention
c. The Office of Minority Health
d. The National Institutes of Health
The Office of Minority Health improves and protects the health of racial and ethnic minority populations through the development of health policies and programs that concentrate on eliminating health disparities. The National Institute on Minority Health and Health Disparities, The Centers for Disease Control and Prevention, and National Institutes of Health all address health disparities among racial and ethnic minorities, but their priority is not in funding these initiatives.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 37
21. Which of the following best demonstrates the practice of transcultural nursing?
a. Using previous knowledge about ethnic minority cultures to plan care
b. Adapting nursing care to meet the need of a person from an ethnic minority
c. Requesting an interpreter when caring for a person from an ethnic minority
d. Attending a presentation about cultural diversity
Transcultural nursing is defined as an area of nursing study and practice that focuses on discovering and explaining cultural factors that influence the health, well-being, illness, or death of individuals or groups and seeks to provide culturally based appropriate care to people of diverse cultures. Adapting nursing care to meet the needs of a person from an ethnic minority best meets this definition of transcultural nursing. A nurse may initially use previous knowledge about minority cultures to plan care, but then must individualize the care based on individual differences within the culture. Having an interpreter present will not be necessary when working with all persons from ethnic minorities. Attending a presentation about cultural diversity would assist the nurse in becoming more culturally competent, but it is not the best example of practicing transcultural nursing because no nursing care is being provided when attending a presentation.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 38
22. A nurse would like to improve his cultural competence. Which of the following is the best strategy to use?
a. Explore complementary and alternative medicine practices used by other cultures.
b. Discuss cultural differences with coworkers.
c. Provide care to diverse populations.
d. Participate in continuing education programs about cultural diversity.
Salman et al. (2007) assessed cultural awareness and cultural competence levels among staff nurses who participated in a continuing education program aimed at increasing knowledge of culturally competent care of geriatric populations. Staff nurses who participated in this training program had higher cultural competence levels as compared with those who did not join this training program. Exploring complementary and alternative medicine practices used by other cultures will assist if a nurse is using these practices; however, depending on whom the nurse is caring for, this information may have limited usefulness. Discussing cultural differences with coworkers may help the nurse learn about other cultures, but it may not provide the best source of information. Providing care to diverse populations may not help the nurse to become more culturally competent without having some baseline knowledge about cultural diversity.
DIF: Cognitive Level: Apply (Application) REF: p. 26 (Box 2-3)
23. A nurse is told by a colleague that an Asian American individual on home care is using complementary and alternative medicine (CAM). Which of the following conclusions can accurately be drawn from this statement?
a. The client will have adverse complications from using this form of medicine.
b. The client may be using meditation, acupuncture, or another therapy.
c. The client will soon be returning to his or her native country for further treatment.
d. The client does not agree with the current professional care medication regimen.
Examples of complementary and alternative medicine (CAM) include acupuncture, feedback, relaxation, music therapy, massage, art, music, and dance therapy. Persons who do not experience relief from chronic conditions often resort to complementary alternative medicine. It is important the nurse learn more about the CAM that the person is using so that any potential interactions between the use of CAM and professional care can be addressed. Complementary and alternative medicine can be used in conjunction with the use of professional care.
DIF: Cognitive Level: Apply (Application) REF: p. 30 (Box 2-4)
24. A woman reports that she has strong spiritual practices. Which of the following is she most likely to experience?
a. Improved coping skills and social support
b. Increased understanding of religious differences
c. Decreased pain and improved healing
d. Decreased use of Western medicine
Spiritual practices are likely to improve coping skills and social support, promote feelings of optimism and home, encourage healthy behavior, decrease feelings of depression and anxiety, and support a sense of relaxation.
DIF: Cognitive Level: Apply (Application) REF: p. 39 (Box 2-5)
1. Which of the following individuals will most likely experience a disparity in health and health care? (select all that apply)
a. African American man
b. Unemployed woman
c. White middle-aged man
d. Single white woman
ANS: A, B, D
Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. A white middle-aged man is the only individual who does not meet that definition.
DIF: Cognitive Level: Apply (Application) REF: p. 23
2. A health care professional is providing culturally competent care. Which of the following actions is being performed by the professional? (select all that apply)
a. Recognizing and accepting cultural diversity
b. Respecting the patient’s values, beliefs, and expectations
c. Understanding the pathophysiology of disease processes
d. Providing health care services that are respectful of the individual’s cultural beliefs
ANS: B, D
A culturally competent health care professional should be able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the patient or client; respect the individual’s values and beliefs; and adjust the approach of delivering care to meet each individual’s needs and expectations. Simply recognizing and accepting cultural diversity and understanding the pathophysiology of disease processes are insufficient measures to reach cultural competency in health care.
DIF: Cognitive Level: Apply (Application) REF: p. 26
3. A health care provider is discussing the importance of receiving routine preventive care with a Hispanic family who has recently immigrated to the United States. Which of the following would best describe why they may be disinterested in receiving professional care? (select all that apply)
a. Lack of folk remedies
b. Lack of interpreter services
c. Lack of health insurance
d. Lack of family support
ANS: B, C
Barriers experienced by Hispanic Americans in receiving appropriate health care services include lack of racial and ethnic diversity in the leadership and workforce of the health care system, lack of interpreter services for Spanish-speaking people, lack of health insurance, and lack of or inadequate culturally appropriate health care resources. They may not readily seek care because of their continued reliance on their folk system of healing. The family is the most important source of support for Hispanic Americans.
DIF: Cognitive Level: Apply (Application) REF: p. 31
4. A nurse is developing a continuing education program about strategies to work with culturally diverse populations for health care professionals in the community. Which of the following organizations would provide information that could be included in this presentation? (select all that apply)
a. The American Nurses Association
b. Sigma Theta Tau International
c. The National League for Nursing
d. The American Association of Colleges of Nursing
ANS: A, C, D
Major organizations, such as the American Nurses Association (ANA), the National League for Nursing (NLN), and the American Association of Colleges of Nursing (AACN), publish culturally relevant materials to guide students, clinicians, and educators.
DIF: Cognitive Level: Apply (Application) REF: p. 38