NR 601 Week 5 Exam with accurate detailed ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answers
Hector Ramirez is a physically active 76-year-old male with history of hypertension, type II
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diabetes mellitus, hyperlipidemia, and history of myocardial infarction 2 years prior, now ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
presenting to establish care with you. He comes into your clinic with a man he introduces as ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
his roommate. Hector has no acute complaints. He reports his health is robust and he is
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independent in his activities of daily living (ADLs) and instrumental ADLs (IADLs). He walks ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
independently without an assistive device and denies any recent falls. He still does some ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
part-time work as a lawyer. For leisure, he enjoys swimming in the morning and walking his ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dog throughout the day. He denies hearing or vision issues and reports he is up to date on
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routine vaccinations. - correct answer✔✔He continues answering your questions, denying
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any substance use, and reporting that he is currently sexually active with men only. He then
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pauses, grasping the hand of his roommate. He endorses that he has never told any health
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provider about his sexuality before because no one had ever cared to ask if he had sex with ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
men. He reports he has been with his roommate for 35 years and self-identifies as gay.
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1) What additional information would be helpful for determining his care needs and
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appropriate laboratory testing? sexual history and depression screening ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2) What may be additional healthcare considerations in care for this older gay male?
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Advanced care planning ||\\//|| ||\\//||
With an open discussion, you screen Hector for depression, which he currently denies,
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although he states he has been treated for depression in the past. He reflects that he is well ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
supported by his roommate, Roy. At this time, your patient seems a bit worried and asks you ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what would be appropriate preventative healthcare screening for him today.
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He states that he has heard of anal Pap smears from friends and would be open to
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scheduling an appointment for testing. He understands that if he has positive results, he may ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
need to undergo further testing.
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You ask him about his sexual habits, and he states he has had multiple sexual partners in the
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last year and is versatile, both bottoming (or receptive anal intercourse) and topping
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,(insertive anal intercourse) with multiple men. He rarely uses barrier protection and has at ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
least three sexual partners. - correct answer✔✔You offer him rectal, oral, and urine testing
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for gonorrhea and chlamydia, in addition to syphilis testing and HIV testing. You counsel him
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on using protection as well, given he has multiple sexual partners. Finally, you have some
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time left in your visit today. You ask open-ended questions about who would make decisions
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for him in emergencies or care for him if he was unable to care for himself. He reports it
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would be his roommate, Roy. You ask him if Roy is his partner and if they have any legal
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documentation showing these are his care preferences. He reports he does not have any ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
legal documentation or license showing Roy is his surrogate decision maker and partner.
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1) What are important advanced care planning considerations in the LGBT community?
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whether paperwork has been completed. Are they married ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2) What social structures do LGBT adults rely on
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Families of choice ||\\//|| ||\\//||
After speaking with Hector, you clarify that his primary surrogate decision maker would be
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his roommate, Roy, with a secondary surrogate his close lifelong friend, Martha. You firmly
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tell Hector that he will need to file advance directive paperwork to recognize his chosen
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individuals as surrogate decision makers. You arrange for follow-up in 4 weeks to continue ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
your goals of care discussion. You have given Hector several items to think about, and he is
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excited to continue his healthcare with you. - correct answer✔✔After speaking with Hector,
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you clarify that his primary surrogate decision maker would be his roommate, Roy, with a
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secondary surrogate his close lifelong friend, Martha. You firmly tell Hector that he will need ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
to file advance directive paperwork to recognize his chosen individuals as surrogate decision
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makers. You arrange for follow-up in 4 weeks to continue your goals of care discussion. You
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have given Hector several items to think about, and he is excited to continue his healthcare
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with you. ||\\//||
Margaret is a 74-year-old female with a history of hypertension, prior smoking, and high ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
cholesterol who is presenting to establish care with you after she moved into assisted living. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
You greet Margaret and see she looks noticeably uncomfortable. You go through your routine
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interview—touching on past medical history and medications—and note that Margaret has
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been on long-term estrogen therapy and has had a vaginoplasty. Knowing this information,
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you pause and ask Margaret what pronouns and names she prefers to use. - correct
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,answer✔✔She endorses her pronouns as "she/her/hers" and states her preferred name is in ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
fact Margaret. She breathes a sigh of relief and reveals that she has jumped from provider to
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provider because of not feeling accepted as a transgender woman and has deferred much of
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her medical care because of not feeling safe with her last provider. When you ask what her
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chief concern is today, she reveals that she seeks a refill of her estrogen as she is about to
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run out.She specifically asks you if she can continue using her estrogen therapy and if you
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would provide the refill. She has been using the same dose of estrogen patch for the last 30
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years.
1) What are issues specific to the care of transgender women and men and how do we
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effectively manage these concerns? ||\\//|| ||\\//|| ||\\//||
2) What risk factors may transgender patients have for osteoporosis?
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Talking with Margaret, you learn she is independent in all her ADLs, although for her IADLs
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she no longer drives or goes grocery shopping on her own. She reports with the loss of
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some of her night vision and slower reaction speed, she simply did not feel safe behind the
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wheel anymore. She enjoys assisted living and getting help with cleaning and her meals.
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Otherwise, she reports no recent falls and denies depression. Asking about her advanced ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
care planning, Margaret does tear up and states her surrogate decision maker is her friend,
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Anne, after her partner of 10 years had passed away. She provides her advanced directive
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showing Anne as her primary healthcare surrogate. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
You then ask her if she is sexually active with men, women, or both. She notes that she is
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currently sexually active with both men and women. - correct answer✔✔Talking with ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Margaret, you learn she is independent in all her ADLs, although for her IADLs she no longer ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
drives or goes grocery shopping on her own. She reports with the loss of some of her night
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vision and slower reaction speed, she simply did not feel safe behind the wheel anymore.
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She enjoys assisted living and getting help with cleaning and her meals. Otherwise, she
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reports no recent falls and denies depression. Asking about her advanced care planning,
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Margaret does tear up and states her surrogate decision maker is her friend, Anne, after her ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
partner of 10 years had passed away. She provides her advanced directive showing Anne as
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her primary healthcare surrogate.
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You then ask her if she is sexually active with men, women, or both. She notes that she is
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currently sexually active with both men and women. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, You conclude your visit offering her STI testing, offering her mammogram screening, and
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letting her know you are here to support her. You will refill her estrogen prescription at this
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time, after discussing the long-term risks of estrogen use, including DVT risk and screening
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her for smoking. However, you wish to hold an ongoing discussion about her estrogen use
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and referral to one of your colleagues who specializes in transgender health. She smiles and
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shakes your hand before you leave the room. - correct answer✔✔You conclude your visit
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offering her STI testing, offering her mammogram screening, and letting her know you are
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here to support her. You will refill her estrogen prescription at this time, after discussing the
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long-term risks of estrogen use, including DVT risk and screening her for smoking. However,||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you wish to hold an ongoing discussion about her estrogen use and referral to one of your
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colleagues who specializes in transgender health. She smiles and shakes your hand before ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you leave the room.
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LGBTQI - correct answer✔✔Umbrella term to describe the community of lesbian gay,
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bisexual, transgender community and etc. ||\\//|| ||\\//|| ||\\//|| ||\\//||
Sexual orientation - correct answer✔✔Emotional, sexual, or romantic fluid attraction
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MSM - correct answer✔✔men who have sex with men
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WSW - correct answer✔✔women who have sex with women
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Gay - correct answer✔✔identity for sexual orientation of individuals who have sex with the
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same gender ||\\//||
Lesbian - correct answer✔✔women who have the sexual orientation towards women
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Bisexual - correct answer✔✔Primary sexual orientation and emotional orientation for both
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genders
answers
Hector Ramirez is a physically active 76-year-old male with history of hypertension, type II
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
diabetes mellitus, hyperlipidemia, and history of myocardial infarction 2 years prior, now ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
presenting to establish care with you. He comes into your clinic with a man he introduces as ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
his roommate. Hector has no acute complaints. He reports his health is robust and he is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
independent in his activities of daily living (ADLs) and instrumental ADLs (IADLs). He walks ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
independently without an assistive device and denies any recent falls. He still does some ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
part-time work as a lawyer. For leisure, he enjoys swimming in the morning and walking his ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dog throughout the day. He denies hearing or vision issues and reports he is up to date on
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
routine vaccinations. - correct answer✔✔He continues answering your questions, denying
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
any substance use, and reporting that he is currently sexually active with men only. He then
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
pauses, grasping the hand of his roommate. He endorses that he has never told any health
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
provider about his sexuality before because no one had ever cared to ask if he had sex with ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
men. He reports he has been with his roommate for 35 years and self-identifies as gay.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1) What additional information would be helpful for determining his care needs and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
appropriate laboratory testing? sexual history and depression screening ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2) What may be additional healthcare considerations in care for this older gay male?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Advanced care planning ||\\//|| ||\\//||
With an open discussion, you screen Hector for depression, which he currently denies,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
although he states he has been treated for depression in the past. He reflects that he is well ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
supported by his roommate, Roy. At this time, your patient seems a bit worried and asks you ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what would be appropriate preventative healthcare screening for him today.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
He states that he has heard of anal Pap smears from friends and would be open to
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
scheduling an appointment for testing. He understands that if he has positive results, he may ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
need to undergo further testing.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
You ask him about his sexual habits, and he states he has had multiple sexual partners in the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
last year and is versatile, both bottoming (or receptive anal intercourse) and topping
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,(insertive anal intercourse) with multiple men. He rarely uses barrier protection and has at ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
least three sexual partners. - correct answer✔✔You offer him rectal, oral, and urine testing
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
for gonorrhea and chlamydia, in addition to syphilis testing and HIV testing. You counsel him
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
on using protection as well, given he has multiple sexual partners. Finally, you have some
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
time left in your visit today. You ask open-ended questions about who would make decisions
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
for him in emergencies or care for him if he was unable to care for himself. He reports it
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
would be his roommate, Roy. You ask him if Roy is his partner and if they have any legal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
documentation showing these are his care preferences. He reports he does not have any ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
legal documentation or license showing Roy is his surrogate decision maker and partner.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1) What are important advanced care planning considerations in the LGBT community?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
whether paperwork has been completed. Are they married ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2) What social structures do LGBT adults rely on
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Families of choice ||\\//|| ||\\//||
After speaking with Hector, you clarify that his primary surrogate decision maker would be
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
his roommate, Roy, with a secondary surrogate his close lifelong friend, Martha. You firmly
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
tell Hector that he will need to file advance directive paperwork to recognize his chosen
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
individuals as surrogate decision makers. You arrange for follow-up in 4 weeks to continue ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
your goals of care discussion. You have given Hector several items to think about, and he is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
excited to continue his healthcare with you. - correct answer✔✔After speaking with Hector,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you clarify that his primary surrogate decision maker would be his roommate, Roy, with a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
secondary surrogate his close lifelong friend, Martha. You firmly tell Hector that he will need ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
to file advance directive paperwork to recognize his chosen individuals as surrogate decision
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
makers. You arrange for follow-up in 4 weeks to continue your goals of care discussion. You
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
have given Hector several items to think about, and he is excited to continue his healthcare
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
with you. ||\\//||
Margaret is a 74-year-old female with a history of hypertension, prior smoking, and high ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
cholesterol who is presenting to establish care with you after she moved into assisted living. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
You greet Margaret and see she looks noticeably uncomfortable. You go through your routine
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
interview—touching on past medical history and medications—and note that Margaret has
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
been on long-term estrogen therapy and has had a vaginoplasty. Knowing this information,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you pause and ask Margaret what pronouns and names she prefers to use. - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,answer✔✔She endorses her pronouns as "she/her/hers" and states her preferred name is in ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
fact Margaret. She breathes a sigh of relief and reveals that she has jumped from provider to
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
provider because of not feeling accepted as a transgender woman and has deferred much of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
her medical care because of not feeling safe with her last provider. When you ask what her
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
chief concern is today, she reveals that she seeks a refill of her estrogen as she is about to
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
run out.She specifically asks you if she can continue using her estrogen therapy and if you
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
would provide the refill. She has been using the same dose of estrogen patch for the last 30
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
years.
1) What are issues specific to the care of transgender women and men and how do we
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
effectively manage these concerns? ||\\//|| ||\\//|| ||\\//||
2) What risk factors may transgender patients have for osteoporosis?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Talking with Margaret, you learn she is independent in all her ADLs, although for her IADLs
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she no longer drives or goes grocery shopping on her own. She reports with the loss of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
some of her night vision and slower reaction speed, she simply did not feel safe behind the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
wheel anymore. She enjoys assisted living and getting help with cleaning and her meals.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Otherwise, she reports no recent falls and denies depression. Asking about her advanced ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
care planning, Margaret does tear up and states her surrogate decision maker is her friend,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Anne, after her partner of 10 years had passed away. She provides her advanced directive
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
showing Anne as her primary healthcare surrogate. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
You then ask her if she is sexually active with men, women, or both. She notes that she is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
currently sexually active with both men and women. - correct answer✔✔Talking with ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Margaret, you learn she is independent in all her ADLs, although for her IADLs she no longer ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
drives or goes grocery shopping on her own. She reports with the loss of some of her night
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
vision and slower reaction speed, she simply did not feel safe behind the wheel anymore.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
She enjoys assisted living and getting help with cleaning and her meals. Otherwise, she
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
reports no recent falls and denies depression. Asking about her advanced care planning,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Margaret does tear up and states her surrogate decision maker is her friend, Anne, after her ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
partner of 10 years had passed away. She provides her advanced directive showing Anne as
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
her primary healthcare surrogate.
||\\//|| ||\\//|| ||\\//||
You then ask her if she is sexually active with men, women, or both. She notes that she is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
currently sexually active with both men and women. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, You conclude your visit offering her STI testing, offering her mammogram screening, and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
letting her know you are here to support her. You will refill her estrogen prescription at this
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
time, after discussing the long-term risks of estrogen use, including DVT risk and screening
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
her for smoking. However, you wish to hold an ongoing discussion about her estrogen use
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and referral to one of your colleagues who specializes in transgender health. She smiles and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
shakes your hand before you leave the room. - correct answer✔✔You conclude your visit
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
offering her STI testing, offering her mammogram screening, and letting her know you are
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
here to support her. You will refill her estrogen prescription at this time, after discussing the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
long-term risks of estrogen use, including DVT risk and screening her for smoking. However,||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you wish to hold an ongoing discussion about her estrogen use and referral to one of your
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
colleagues who specializes in transgender health. She smiles and shakes your hand before ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you leave the room.
||\\//|| ||\\//|| ||\\//||
LGBTQI - correct answer✔✔Umbrella term to describe the community of lesbian gay,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
bisexual, transgender community and etc. ||\\//|| ||\\//|| ||\\//|| ||\\//||
Sexual orientation - correct answer✔✔Emotional, sexual, or romantic fluid attraction
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
MSM - correct answer✔✔men who have sex with men
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
WSW - correct answer✔✔women who have sex with women
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Gay - correct answer✔✔identity for sexual orientation of individuals who have sex with the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
same gender ||\\//||
Lesbian - correct answer✔✔women who have the sexual orientation towards women
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Bisexual - correct answer✔✔Primary sexual orientation and emotional orientation for both
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
genders
