FAMILY PRACTICE GUIDELINES
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
Ch. 1 — Health Maintenance — Cultural Diversity and
Sensitivity
Stem: A 54-year-old Somali woman presents for a routine visit.
She avoids influenza vaccination because of cultural beliefs and
limited English; her husband interprets intermittently. She has
type 2 diabetes and is incompletely adherent to metformin. As
the APRN, you must balance respect for cultural values with
evidence-based preventive care. What is the best immediate
next step?
A. Respectfully document refusal and provide no further
vaccine counseling.
B. Arrange for a trained medical interpreter and use culturally
tailored vaccine education, exploring beliefs and barriers.
C. Offer written vaccine information in English and ask the
husband to explain.
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,D. Defer discussion until the next visit to avoid offending the
patient.
Correct: B
Rationale — Correct (B): Use of a trained interpreter and
culturally tailored counseling addresses language barriers and
health beliefs while enabling shared decision-making. This
approach increases vaccine uptake in patients with cultural
hesitancy and aligns with recommended preventive strategies.
It also protects confidentiality and reduces clinician-mediated
misinformation.
Rationale — A: Documenting refusal without counseling misses
an opportunity for informed consent and fails to address
modifiable barriers.
Rationale — C: Relying on a family member for interpretation
risks inaccuracies and breaches confidentiality.
Rationale — D: Deferring care prolongs risk — immediate,
respectful education is evidence-based.
Teaching point: Always use trained interpreters and culturally
tailored counseling for preventive care.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Ch. 1 — Health Maintenance — Health Maintenance During the
Life Span (Adult Preventive Healthcare)
Stem: A 68-year-old man with COPD and a 30-pack-year
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,smoking history asks which cancer screening tests he still needs.
He had colonoscopy at age 60 with normal findings; he quit
smoking 2 years ago. Current vitals and exam are stable. Which
screening recommendation most appropriately balances benefit
and harm?
A. Continue colonoscopy every 5 years because of COPD
comorbidity.
B. Discontinue colorectal cancer screening at age >65 regardless
of prior colonoscopy.
C. Continue CRC screening per prior normal exam and guideline
interval until age 75; offer low-dose CT screening discussion for
lung cancer if he qualifies.
D. Start annual CT abdomen for occult malignancy because of
smoking history.
Correct: C
Rationale — Correct (C): Most guidelines suggest continuing
age-based colorectal screening through age 75 if prior exams
were up to date; lung cancer screening (low-dose CT) should be
discussed for eligible long-term smokers. This balances life
expectancy, comorbidities, and screening harms.
Rationale — A: Shortening colonoscopy interval to 5 years
without positive findings is not guideline-based and increases
harm.
Rationale — B: Automatic discontinuation at 65 ignores
individual screening history and life expectancy.
Rationale — D: Annual abdominal CT for occult malignancy is
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, not recommended and exposes the patient to unnecessary
radiation and cost.
Teaching point: Individualize screening by age, prior results, life
expectancy, and guideline eligibility.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Ch. 1 — Health Maintenance — Other Collaborating Providers
Stem: A 44-year-old woman with obesity (BMI 36), knee
osteoarthritis, and uncontrolled hypertension asks whether she
should see physical therapy before surgical referral. She has had
3 months of home exercise with limited improvement. On exam
she has crepitus and 20° limited flexion. Which collaborative
plan aligns best with family practice guidelines?
A. Immediate orthopedic surgical referral for arthroscopy.
B. Refer to physical therapy for supervised exercise, weight-loss
counseling, and consider nutritional referral prior to any
surgical decision.
C. Start opioid analgesic therapy and avoid referrals.
D. Recommend complete rest of the knee and no further
exercise referral.
Correct: B
Rationale — Correct (B): Guidelines emphasize conservative
management (supervised PT, weight loss, and multidisciplinary
care) before surgical referral for osteoarthritis, especially in
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6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
Ch. 1 — Health Maintenance — Cultural Diversity and
Sensitivity
Stem: A 54-year-old Somali woman presents for a routine visit.
She avoids influenza vaccination because of cultural beliefs and
limited English; her husband interprets intermittently. She has
type 2 diabetes and is incompletely adherent to metformin. As
the APRN, you must balance respect for cultural values with
evidence-based preventive care. What is the best immediate
next step?
A. Respectfully document refusal and provide no further
vaccine counseling.
B. Arrange for a trained medical interpreter and use culturally
tailored vaccine education, exploring beliefs and barriers.
C. Offer written vaccine information in English and ask the
husband to explain.
Page | 1
,D. Defer discussion until the next visit to avoid offending the
patient.
Correct: B
Rationale — Correct (B): Use of a trained interpreter and
culturally tailored counseling addresses language barriers and
health beliefs while enabling shared decision-making. This
approach increases vaccine uptake in patients with cultural
hesitancy and aligns with recommended preventive strategies.
It also protects confidentiality and reduces clinician-mediated
misinformation.
Rationale — A: Documenting refusal without counseling misses
an opportunity for informed consent and fails to address
modifiable barriers.
Rationale — C: Relying on a family member for interpretation
risks inaccuracies and breaches confidentiality.
Rationale — D: Deferring care prolongs risk — immediate,
respectful education is evidence-based.
Teaching point: Always use trained interpreters and culturally
tailored counseling for preventive care.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Ch. 1 — Health Maintenance — Health Maintenance During the
Life Span (Adult Preventive Healthcare)
Stem: A 68-year-old man with COPD and a 30-pack-year
Page | 2
,smoking history asks which cancer screening tests he still needs.
He had colonoscopy at age 60 with normal findings; he quit
smoking 2 years ago. Current vitals and exam are stable. Which
screening recommendation most appropriately balances benefit
and harm?
A. Continue colonoscopy every 5 years because of COPD
comorbidity.
B. Discontinue colorectal cancer screening at age >65 regardless
of prior colonoscopy.
C. Continue CRC screening per prior normal exam and guideline
interval until age 75; offer low-dose CT screening discussion for
lung cancer if he qualifies.
D. Start annual CT abdomen for occult malignancy because of
smoking history.
Correct: C
Rationale — Correct (C): Most guidelines suggest continuing
age-based colorectal screening through age 75 if prior exams
were up to date; lung cancer screening (low-dose CT) should be
discussed for eligible long-term smokers. This balances life
expectancy, comorbidities, and screening harms.
Rationale — A: Shortening colonoscopy interval to 5 years
without positive findings is not guideline-based and increases
harm.
Rationale — B: Automatic discontinuation at 65 ignores
individual screening history and life expectancy.
Rationale — D: Annual abdominal CT for occult malignancy is
Page | 3
, not recommended and exposes the patient to unnecessary
radiation and cost.
Teaching point: Individualize screening by age, prior results, life
expectancy, and guideline eligibility.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Ch. 1 — Health Maintenance — Other Collaborating Providers
Stem: A 44-year-old woman with obesity (BMI 36), knee
osteoarthritis, and uncontrolled hypertension asks whether she
should see physical therapy before surgical referral. She has had
3 months of home exercise with limited improvement. On exam
she has crepitus and 20° limited flexion. Which collaborative
plan aligns best with family practice guidelines?
A. Immediate orthopedic surgical referral for arthroscopy.
B. Refer to physical therapy for supervised exercise, weight-loss
counseling, and consider nutritional referral prior to any
surgical decision.
C. Start opioid analgesic therapy and avoid referrals.
D. Recommend complete rest of the knee and no further
exercise referral.
Correct: B
Rationale — Correct (B): Guidelines emphasize conservative
management (supervised PT, weight loss, and multidisciplinary
care) before surgical referral for osteoarthritis, especially in
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