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 38-year-old immigrant woman presents for her first primary-
care visit. She prefers traditional remedies and declines routine
cervical screening because of cultural modesty concerns. Her
history reveals intermittent postcoital spotting. As the APRN,
how do you proceed to balance cultural sensitivity with safety
and evidence-based preventive care?
Options
A. Accept her refusal and document the discussion; defer Pap
testing indefinitely.
Page | 1
,B. Explore cultural beliefs, provide education about risks, offer
female examiner and private chaperone, and negotiate
acceptable screening options (HPV testing or delayed speculum
exam).
C. Insist on immediate speculum exam and Pap smear; schedule
now without further discussion.
D. Refer to community health worker and remove screening
responsibility from primary team.
Correct answer
B
Rationales
Correct (B): This approach integrates respectful cultural
elicitation and shared decision-making. Offering options (HPV
testing, female clinician, chaperone) and explaining risk/benefit
aligns with family practice guidance that emphasizes culturally
sensitive negotiation to promote preventive care while
preserving trust.
A: Passive acceptance risks missing treatable pathology given
her postcoital spotting — not consistent with safety-first
guidance.
C: Coercion can damage trust and reduce future engagement;
not culturally sensitive.
D: Referral without attempting negotiated in-clinic options
relinquishes primary-care role and delays evaluation.
Page | 2
,Teaching point
Elicit beliefs, offer options (female clinician/HPV testing), and
negotiate to ensure safety and engagement.
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 16-year-old adolescent male presents for sports physical. He
reports energy drinks daily, recent 8-lb weight loss, and
intermittent palpitations during basketball. Vitals: BP 110/64,
HR 96, BMI 20. What next-step screening or counseling best
addresses both immediate safety and preventive care?
Options
A. Reassure — normal vitals and encourage more sports drinks.
B. Screen for stimulant use (caffeine/energy drinks), assess for
eating disorders and dehydration, counsel on safe hydration
and stimulant limits.
C. Order immediate ECG and start beta-blocker.
D. Restrict sports participation indefinitely until full cardiology
evaluation.
Page | 3
, Correct answer
B
Rationales
Correct (B): Adolescents commonly use energy drinks; weight
loss and palpitations warrant screening for stimulant ingestion,
disordered eating, orthostasis, and hydration status. The
guideline emphasizes age-appropriate counseling and targeted
screening before invasive testing.
A: Dismisses potential risks and misses chance for harm-
reduction counseling.
C: ECG may be considered if red flags (syncope, family history);
immediate beta-blocker without diagnosis is inappropriate.
D: Indiscriminate restriction harms development and is
excessive unless high-risk features are present.
Teaching point
Screen adolescents for stimulant use and eating disorders;
counsel on hydration and safe stimulant limits.
Citation
Cash, J. C. (2025). Family Practice Guidelines (6th Ed.). Ch. 1.
3
Reference
Ch. 1 — Health Maintenance Guidelines — Other Collaborating
Providers
Page | 4
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference
Ch. 1 — Health Maintenance Guidelines — Cultural Diversity
and Sensitivity
Stem
A 38-year-old immigrant woman presents for her first primary-
care visit. She prefers traditional remedies and declines routine
cervical screening because of cultural modesty concerns. Her
history reveals intermittent postcoital spotting. As the APRN,
how do you proceed to balance cultural sensitivity with safety
and evidence-based preventive care?
Options
A. Accept her refusal and document the discussion; defer Pap
testing indefinitely.
Page | 1
,B. Explore cultural beliefs, provide education about risks, offer
female examiner and private chaperone, and negotiate
acceptable screening options (HPV testing or delayed speculum
exam).
C. Insist on immediate speculum exam and Pap smear; schedule
now without further discussion.
D. Refer to community health worker and remove screening
responsibility from primary team.
Correct answer
B
Rationales
Correct (B): This approach integrates respectful cultural
elicitation and shared decision-making. Offering options (HPV
testing, female clinician, chaperone) and explaining risk/benefit
aligns with family practice guidance that emphasizes culturally
sensitive negotiation to promote preventive care while
preserving trust.
A: Passive acceptance risks missing treatable pathology given
her postcoital spotting — not consistent with safety-first
guidance.
C: Coercion can damage trust and reduce future engagement;
not culturally sensitive.
D: Referral without attempting negotiated in-clinic options
relinquishes primary-care role and delays evaluation.
Page | 2
,Teaching point
Elicit beliefs, offer options (female clinician/HPV testing), and
negotiate to ensure safety and engagement.
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 16-year-old adolescent male presents for sports physical. He
reports energy drinks daily, recent 8-lb weight loss, and
intermittent palpitations during basketball. Vitals: BP 110/64,
HR 96, BMI 20. What next-step screening or counseling best
addresses both immediate safety and preventive care?
Options
A. Reassure — normal vitals and encourage more sports drinks.
B. Screen for stimulant use (caffeine/energy drinks), assess for
eating disorders and dehydration, counsel on safe hydration
and stimulant limits.
C. Order immediate ECG and start beta-blocker.
D. Restrict sports participation indefinitely until full cardiology
evaluation.
Page | 3
, Correct answer
B
Rationales
Correct (B): Adolescents commonly use energy drinks; weight
loss and palpitations warrant screening for stimulant ingestion,
disordered eating, orthostasis, and hydration status. The
guideline emphasizes age-appropriate counseling and targeted
screening before invasive testing.
A: Dismisses potential risks and misses chance for harm-
reduction counseling.
C: ECG may be considered if red flags (syncope, family history);
immediate beta-blocker without diagnosis is inappropriate.
D: Indiscriminate restriction harms development and is
excessive unless high-risk features are present.
Teaching point
Screen adolescents for stimulant use and eating disorders;
counsel on hydration and safe stimulant limits.
Citation
Cash, J. C. (2025). Family Practice Guidelines (6th Ed.). Ch. 1.
3
Reference
Ch. 1 — Health Maintenance Guidelines — Other Collaborating
Providers
Page | 4
