FAMILY PRACTICE GUIDELINES
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity and Sensitivity
Stem: A 62-year-old Somali woman with limited English and no
prior preventive care presents for a new patient visit. She
requests “routine checks” but declines a pelvic exam due to
cultural modesty. Her medical history is unknown and she has
uncontrolled hypertension recorded at triage. As the APRN,
what is the best next step to balance culturally sensitive care
and guideline-based prevention?
A. Defer all screening until the patient consents to a full physical
later.
B. Use a trained medical interpreter, briefly explain needed
screenings, and offer separate female examiner and private
Page | 1
,chaperone for exams.
C. Proceed with all recommended screenings (including pelvic)
because patient safety overrides preference.
D. Schedule only immediate urgent care (BP control) and avoid
discussing preventive screenings now to respect modesty.
Correct Answer: B
Rationales — Correct: Using a trained interpreter and offering
gender-concordant staff or chaperone respects cultural
sensitivity while enabling informed decision-making and
completion of essential preventive tasks (e.g., BP control,
discussion of screenings). This approach aligns with patient-
centered health maintenance principles and reduces barriers to
care. It allows the APRN to prioritize urgent needs
(hypertension) while negotiating culturally acceptable ways to
complete preventive care.
Rationales — Incorrect:
A. Deferring all screening risks missed opportunities and fails to
address urgent hypertension; it’s not aligned with guideline-
based care.
C. Forcing exams disregards autonomy and may harm the
therapeutic alliance; consent remains required.
D. Avoiding preventive discussion eliminates opportunities for
shared decision-making and may delay needed screenings.
Teaching Point: Use interpreters and gender-concordant staff to
respect culture while delivering preventive care.
Page | 2
,Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Reference: Ch. 1 — Health Maintenance Guidelines — Health
Maintenance During the Life Span
Stem: A 28-year-old woman planning pregnancy asks about
preconception care. She has BMI 34, type 2 diabetes controlled
with metformin, and a history of depressive episodes. Which
preconception intervention most reduces maternal and fetal
risks?
A. Recommend discontinuation of metformin and switch to
insulin prior to conception.
B. Begin high-dose folic acid (4 mg daily), optimize glycemic
control, and review psychotropic meds with psychiatry.
C. Advise weight loss only after pregnancy is complete; start
prenatal vitamins now.
D. Start combined hormonal contraceptive until weight loss is
achieved, then attempt conception.
Correct Answer: B
Rationales — Correct: High-risk patients should receive 4 mg
folic acid to reduce neural tube defects, and optimizing
glycemic control before conception reduces congenital
anomalies and adverse outcomes. Reviewing psychotropic
medications with psychiatry balances maternal mental health
Page | 3
, and teratogenic risk. This comprehensive preconception plan
reflects life-span preventive care principles.
Rationales — Incorrect:
A. Routine automatic switch to insulin isn’t necessary for all;
individualized glycemic optimization is the priority.
C. Delaying optimization ignores modifiable preconception
risks; prenatal vitamins alone are insufficient.
D. Starting contraception now without addressing metabolic
control is not the primary intervention for risk reduction.
Teaching Point: Preconception: 4 mg folic acid plus glycemic
and medication optimization.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Reference: Ch. 1 — Health Maintenance Guidelines — Other
Collaborating Providers
Stem: A 75-year-old man with progressive memory decline,
polypharmacy, and falls is seen in primary care. You suspect
early dementia with gait instability. According to guideline
collaboration principles, which specialist referral is most
appropriate first?
A. Orthopedics for fall prevention.
B. Neurology or geriatric medicine for cognitive evaluation and
medication review.
Page | 4
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity and Sensitivity
Stem: A 62-year-old Somali woman with limited English and no
prior preventive care presents for a new patient visit. She
requests “routine checks” but declines a pelvic exam due to
cultural modesty. Her medical history is unknown and she has
uncontrolled hypertension recorded at triage. As the APRN,
what is the best next step to balance culturally sensitive care
and guideline-based prevention?
A. Defer all screening until the patient consents to a full physical
later.
B. Use a trained medical interpreter, briefly explain needed
screenings, and offer separate female examiner and private
Page | 1
,chaperone for exams.
C. Proceed with all recommended screenings (including pelvic)
because patient safety overrides preference.
D. Schedule only immediate urgent care (BP control) and avoid
discussing preventive screenings now to respect modesty.
Correct Answer: B
Rationales — Correct: Using a trained interpreter and offering
gender-concordant staff or chaperone respects cultural
sensitivity while enabling informed decision-making and
completion of essential preventive tasks (e.g., BP control,
discussion of screenings). This approach aligns with patient-
centered health maintenance principles and reduces barriers to
care. It allows the APRN to prioritize urgent needs
(hypertension) while negotiating culturally acceptable ways to
complete preventive care.
Rationales — Incorrect:
A. Deferring all screening risks missed opportunities and fails to
address urgent hypertension; it’s not aligned with guideline-
based care.
C. Forcing exams disregards autonomy and may harm the
therapeutic alliance; consent remains required.
D. Avoiding preventive discussion eliminates opportunities for
shared decision-making and may delay needed screenings.
Teaching Point: Use interpreters and gender-concordant staff to
respect culture while delivering preventive care.
Page | 2
,Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Reference: Ch. 1 — Health Maintenance Guidelines — Health
Maintenance During the Life Span
Stem: A 28-year-old woman planning pregnancy asks about
preconception care. She has BMI 34, type 2 diabetes controlled
with metformin, and a history of depressive episodes. Which
preconception intervention most reduces maternal and fetal
risks?
A. Recommend discontinuation of metformin and switch to
insulin prior to conception.
B. Begin high-dose folic acid (4 mg daily), optimize glycemic
control, and review psychotropic meds with psychiatry.
C. Advise weight loss only after pregnancy is complete; start
prenatal vitamins now.
D. Start combined hormonal contraceptive until weight loss is
achieved, then attempt conception.
Correct Answer: B
Rationales — Correct: High-risk patients should receive 4 mg
folic acid to reduce neural tube defects, and optimizing
glycemic control before conception reduces congenital
anomalies and adverse outcomes. Reviewing psychotropic
medications with psychiatry balances maternal mental health
Page | 3
, and teratogenic risk. This comprehensive preconception plan
reflects life-span preventive care principles.
Rationales — Incorrect:
A. Routine automatic switch to insulin isn’t necessary for all;
individualized glycemic optimization is the priority.
C. Delaying optimization ignores modifiable preconception
risks; prenatal vitamins alone are insufficient.
D. Starting contraception now without addressing metabolic
control is not the primary intervention for risk reduction.
Teaching Point: Preconception: 4 mg folic acid plus glycemic
and medication optimization.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Reference: Ch. 1 — Health Maintenance Guidelines — Other
Collaborating Providers
Stem: A 75-year-old man with progressive memory decline,
polypharmacy, and falls is seen in primary care. You suspect
early dementia with gait instability. According to guideline
collaboration principles, which specialist referral is most
appropriate first?
A. Orthopedics for fall prevention.
B. Neurology or geriatric medicine for cognitive evaluation and
medication review.
Page | 4
