FAMILY PRACTICE GUIDELINES
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. Health Maintenance Guidelines — Cultural
Diversity and Sensitivity
Stem: A 58-year-old male from a Somali immigrant community
presents for well visit and expresses hesitancy toward
colonoscopy because of cultural modesty and distrust of
healthcare institutions. He has a family history of colorectal
cancer (father at 62). Which next-step approach best balances
cancer screening urgency with cultural sensitivity?
A. Schedule colonoscopy immediately and emphasize cancer
risk.
B. Offer fecal immunochemical testing (FIT) with culturally
tailored education and an interpreter.
Page | 1
,C. Defer screening until he expresses readiness to undergo
colonoscopy.
D. Recommend no screening because ultrasound is noninvasive
and patient prefers it.
Correct answer: B
Rationale (correct): Offering FIT plus culturally tailored
education and interpreter services is evidence-based, preserves
screening uptake while respecting cultural concerns, and is
aligned with family practice guidance to use less invasive
screening when appropriate. FIT provides actionable results and
facilitates shared decision-making.
Rationale (incorrect):
A: Immediate colonoscopy may alienate the patient and reduce
adherence without shared decision-making.
C: Deferral risks missed early detection when a reasonable
alternative exists.
D: Ultrasound is not an effective colorectal cancer screening
tool.
Teaching point: Use culturally adapted education and
noninvasive screening (FIT) to improve uptake.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. Health Maintenance Guidelines.
2
Reference: Ch. Health Maintenance Guidelines — Health
Maintenance During the Life Span
Page | 2
,Stem: A 16-year-old female athlete requests HPV vaccination at
a routine sports physical. She is sexually active and has
incomplete immunization history. Which is the best APRN
decision?
A. Defer HPV vaccine until age 18 and reassess.
B. Administer HPV vaccine now and provide counseling about
sexual health and consent.
C. Only provide condoms and postpone vaccine due to sexual
activity.
D. Order HPV DNA testing first, then decide about vaccination.
Correct answer: B
Rationale (correct): Administering HPV vaccine is appropriate
for a sexually active adolescent up to age 26 (and
recommended starting earlier); it remains effective and should
not be withheld for sexual activity. Counseling and consent are
necessary. This aligns with lifespan preventive guidance.
Rationale (incorrect):
A: Deferring misses an opportunity for protection and
contradicts vaccination guidance.
C: Condoms are complementary but do not replace vaccine
protection against HPV.
D: HPV DNA testing is not indicated as prerequisite for
vaccination in adolescents.
Teaching point: Provide HPV vaccination at opportunity; sexual
activity is not a contraindication.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. Health Maintenance Guidelines.
Page | 3
, 3
Reference: Ch. Health Maintenance Guidelines — Other
Collaborating Providers
Stem: A 72-year-old woman with frailty, polypharmacy, and
early dementia has recurrent falls. As the APRN managing her
primary care, which referral will most directly target fall
reduction and functional independence?
A. Refer to cardiology for tilt-table testing.
B. Refer to occupational therapy for home safety and ADL
assessment.
C. Refer to dermatology for skin protection.
D. Refer to endocrinology for osteoporosis medications.
Correct answer: B
Rationale (correct): Occupational therapy evaluates home
environment, ADLs, adaptive devices and provides interventions
to reduce fall risk and preserve independence—immediate,
practical steps per family practice guidelines. Multidisciplinary
care is crucial.
Rationale (incorrect):
A: Cardiology may be relevant for syncope but is less
immediately impactful than home safety interventions for falls.
C: Dermatology is unrelated to recurrent falls.
D: Treating osteoporosis is important but does not directly
prevent immediate fall hazards in the home.
Teaching point: Prioritize rehab and home-safety referrals to
Page | 4
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. Health Maintenance Guidelines — Cultural
Diversity and Sensitivity
Stem: A 58-year-old male from a Somali immigrant community
presents for well visit and expresses hesitancy toward
colonoscopy because of cultural modesty and distrust of
healthcare institutions. He has a family history of colorectal
cancer (father at 62). Which next-step approach best balances
cancer screening urgency with cultural sensitivity?
A. Schedule colonoscopy immediately and emphasize cancer
risk.
B. Offer fecal immunochemical testing (FIT) with culturally
tailored education and an interpreter.
Page | 1
,C. Defer screening until he expresses readiness to undergo
colonoscopy.
D. Recommend no screening because ultrasound is noninvasive
and patient prefers it.
Correct answer: B
Rationale (correct): Offering FIT plus culturally tailored
education and interpreter services is evidence-based, preserves
screening uptake while respecting cultural concerns, and is
aligned with family practice guidance to use less invasive
screening when appropriate. FIT provides actionable results and
facilitates shared decision-making.
Rationale (incorrect):
A: Immediate colonoscopy may alienate the patient and reduce
adherence without shared decision-making.
C: Deferral risks missed early detection when a reasonable
alternative exists.
D: Ultrasound is not an effective colorectal cancer screening
tool.
Teaching point: Use culturally adapted education and
noninvasive screening (FIT) to improve uptake.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. Health Maintenance Guidelines.
2
Reference: Ch. Health Maintenance Guidelines — Health
Maintenance During the Life Span
Page | 2
,Stem: A 16-year-old female athlete requests HPV vaccination at
a routine sports physical. She is sexually active and has
incomplete immunization history. Which is the best APRN
decision?
A. Defer HPV vaccine until age 18 and reassess.
B. Administer HPV vaccine now and provide counseling about
sexual health and consent.
C. Only provide condoms and postpone vaccine due to sexual
activity.
D. Order HPV DNA testing first, then decide about vaccination.
Correct answer: B
Rationale (correct): Administering HPV vaccine is appropriate
for a sexually active adolescent up to age 26 (and
recommended starting earlier); it remains effective and should
not be withheld for sexual activity. Counseling and consent are
necessary. This aligns with lifespan preventive guidance.
Rationale (incorrect):
A: Deferring misses an opportunity for protection and
contradicts vaccination guidance.
C: Condoms are complementary but do not replace vaccine
protection against HPV.
D: HPV DNA testing is not indicated as prerequisite for
vaccination in adolescents.
Teaching point: Provide HPV vaccination at opportunity; sexual
activity is not a contraindication.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. Health Maintenance Guidelines.
Page | 3
, 3
Reference: Ch. Health Maintenance Guidelines — Other
Collaborating Providers
Stem: A 72-year-old woman with frailty, polypharmacy, and
early dementia has recurrent falls. As the APRN managing her
primary care, which referral will most directly target fall
reduction and functional independence?
A. Refer to cardiology for tilt-table testing.
B. Refer to occupational therapy for home safety and ADL
assessment.
C. Refer to dermatology for skin protection.
D. Refer to endocrinology for osteoporosis medications.
Correct answer: B
Rationale (correct): Occupational therapy evaluates home
environment, ADLs, adaptive devices and provides interventions
to reduce fall risk and preserve independence—immediate,
practical steps per family practice guidelines. Multidisciplinary
care is crucial.
Rationale (incorrect):
A: Cardiology may be relevant for syncope but is less
immediately impactful than home safety interventions for falls.
C: Dermatology is unrelated to recurrent falls.
D: Treating osteoporosis is important but does not directly
prevent immediate fall hazards in the home.
Teaching point: Prioritize rehab and home-safety referrals to
Page | 4
