FAMILY PRACTICE GUIDELINES
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 58-year-old male from a recent immigrant community
presents for an annual exam. He prefers traditional healers and
declines colorectal screening citing cultural beliefs. He has
controlled hypertension and a family history of colon cancer. As
the APRN, how do you proceed to best address preventive care
and cultural sensitivity?
Options:
A. Respectfully document refusal and schedule routine follow-
up in one year.
B. Provide a culturally tailored explanation linking colon cancer
risk to family history and offering a choice of stool-based
Page | 1
,screening.
C. Insist on colonoscopy as standard of care and arrange
immediate referral.
D. Explain risks and advise no screening unless symptoms
develop.
Correct Answer: B
Rationale — Correct: Offering culturally tailored education and
an alternative evidence-based screening (stool-based) balances
respect and preventive care; it addresses family history risk
while respecting patient preferences and increases uptake.
Family Practice Guidelines emphasize shared decision-making
and offering acceptable screening modalities.
Rationale — Incorrect:
A. Passive documentation ignores family risk and missed
opportunity to negotiate acceptable screening.
C. Insisting on colonoscopy is coercive and may reduce trust and
adherence.
D. Waiting for symptoms delays detection and contradicts
preventive guidance for high-risk patients.
Teaching Point: Offer culturally acceptable screening options
and shared decision-making.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Page | 2
,Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 34-year-old pregnant patient who speaks limited
English declines influenza vaccine because of misinformation
from family members. She is G2P1 at 16 weeks with mild
asthma. You suspect increased maternal and fetal risk if
unvaccinated. What is the APRN’s best immediate step?
Options:
A. Defer vaccination and provide a pamphlet in English.
B. Use a trained medical interpreter to address safety evidence
and offer vaccination now.
C. Ask family to convince her since they influence decision-
making.
D. Note refusal and revisit only in third trimester.
Correct Answer: B
Rationale — Correct: Using a trained interpreter ensures
accurate communication; providing evidence of safety in
pregnancy and offering vaccination now addresses both
cultural/language barriers and immediate maternal–fetal risk
(asthma increases influenza complications). FPG supports
vaccination in pregnancy.
Rationale — Incorrect:
A. Pamphlet in English is ineffective for limited English
proficiency.
C. Family persuasion without clinician counseling may
perpetuate misinformation.
D. Delaying increases risk; influenza vaccination recommended
Page | 3
, during pregnancy at any trimester.
Teaching Point: Use trained interpreters and offer pregnancy-
safe vaccines promptly.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Reference: Ch. 1 — Health Maintenance Guidelines — Health
Maintenance During the Life Span
Stem: A 72-year-old woman with moderate cognitive
impairment and multiple comorbidities presents for annual
preventive visit. She lives with daughter who handles medical
decisions. Which preventive interventions are high priority and
align with life-span health maintenance?
Options:
A. Initiate mammography and colonoscopy screening per age
cutoffs.
B. Focus on immunizations (influenza, pneumococcal, zoster)
and fall-risk assessment.
C. Schedule routine bone density screening only.
D. Defer all preventive care due to cognitive impairment.
Correct Answer: B
Rationale — Correct: For older adults with
comorbidity/cognitive impairment, immunizations and fall-risk
mitigation are high-value, low-burden interventions that
improve morbidity. FPG emphasizes individualized preventive
Page | 4
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 58-year-old male from a recent immigrant community
presents for an annual exam. He prefers traditional healers and
declines colorectal screening citing cultural beliefs. He has
controlled hypertension and a family history of colon cancer. As
the APRN, how do you proceed to best address preventive care
and cultural sensitivity?
Options:
A. Respectfully document refusal and schedule routine follow-
up in one year.
B. Provide a culturally tailored explanation linking colon cancer
risk to family history and offering a choice of stool-based
Page | 1
,screening.
C. Insist on colonoscopy as standard of care and arrange
immediate referral.
D. Explain risks and advise no screening unless symptoms
develop.
Correct Answer: B
Rationale — Correct: Offering culturally tailored education and
an alternative evidence-based screening (stool-based) balances
respect and preventive care; it addresses family history risk
while respecting patient preferences and increases uptake.
Family Practice Guidelines emphasize shared decision-making
and offering acceptable screening modalities.
Rationale — Incorrect:
A. Passive documentation ignores family risk and missed
opportunity to negotiate acceptable screening.
C. Insisting on colonoscopy is coercive and may reduce trust and
adherence.
D. Waiting for symptoms delays detection and contradicts
preventive guidance for high-risk patients.
Teaching Point: Offer culturally acceptable screening options
and shared decision-making.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Page | 2
,Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 34-year-old pregnant patient who speaks limited
English declines influenza vaccine because of misinformation
from family members. She is G2P1 at 16 weeks with mild
asthma. You suspect increased maternal and fetal risk if
unvaccinated. What is the APRN’s best immediate step?
Options:
A. Defer vaccination and provide a pamphlet in English.
B. Use a trained medical interpreter to address safety evidence
and offer vaccination now.
C. Ask family to convince her since they influence decision-
making.
D. Note refusal and revisit only in third trimester.
Correct Answer: B
Rationale — Correct: Using a trained interpreter ensures
accurate communication; providing evidence of safety in
pregnancy and offering vaccination now addresses both
cultural/language barriers and immediate maternal–fetal risk
(asthma increases influenza complications). FPG supports
vaccination in pregnancy.
Rationale — Incorrect:
A. Pamphlet in English is ineffective for limited English
proficiency.
C. Family persuasion without clinician counseling may
perpetuate misinformation.
D. Delaying increases risk; influenza vaccination recommended
Page | 3
, during pregnancy at any trimester.
Teaching Point: Use trained interpreters and offer pregnancy-
safe vaccines promptly.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Reference: Ch. 1 — Health Maintenance Guidelines — Health
Maintenance During the Life Span
Stem: A 72-year-old woman with moderate cognitive
impairment and multiple comorbidities presents for annual
preventive visit. She lives with daughter who handles medical
decisions. Which preventive interventions are high priority and
align with life-span health maintenance?
Options:
A. Initiate mammography and colonoscopy screening per age
cutoffs.
B. Focus on immunizations (influenza, pneumococcal, zoster)
and fall-risk assessment.
C. Schedule routine bone density screening only.
D. Defer all preventive care due to cognitive impairment.
Correct Answer: B
Rationale — Correct: For older adults with
comorbidity/cognitive impairment, immunizations and fall-risk
mitigation are high-value, low-burden interventions that
improve morbidity. FPG emphasizes individualized preventive
Page | 4
