NR 601 Week 5 full exams with
complete questions and correct
solutions 100 % guaranteed success.
GOODLUCK
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
Transgender - Correct Answer: A person who identifies as a gender that is not their gender at birth.
Genderqueer and does not identify within to gender binary.
Queer - Correct Answer: Term to include younger LGBTQI members who do not identify with other
genders or sexual identities yet or ever.
Gender dysphoria - Correct Answer: Distress that is caused by a discrepancy between a person's gender
identity and that person's sex assigned at birth. This distress may also be from the associated gender
role or attributed sex characteristics.
Gender identity - Correct Answer: A person's intrinsic sense of being male, female, or an alternative
gender
Sex - Correct Answer: Sex is assigned at birth as male or female, usually based on the appearance of the
external genitalia. Natal gender.
Gender expression - Correct Answer: The way an individual socially expresses gender, such as style of
clothing, speech, and mannerisms. Gender identity and gender expression may differ. There may also be
people who do not present in the binary or masculine or feminine roles, presenting as an alternate
gender, such as genderqueer.
complete questions and correct
solutions 100 % guaranteed success.
GOODLUCK
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
Transgender - Correct Answer: A person who identifies as a gender that is not their gender at birth.
Genderqueer and does not identify within to gender binary.
Queer - Correct Answer: Term to include younger LGBTQI members who do not identify with other
genders or sexual identities yet or ever.
Gender dysphoria - Correct Answer: Distress that is caused by a discrepancy between a person's gender
identity and that person's sex assigned at birth. This distress may also be from the associated gender
role or attributed sex characteristics.
Gender identity - Correct Answer: A person's intrinsic sense of being male, female, or an alternative
gender
Sex - Correct Answer: Sex is assigned at birth as male or female, usually based on the appearance of the
external genitalia. Natal gender.
Gender expression - Correct Answer: The way an individual socially expresses gender, such as style of
clothing, speech, and mannerisms. Gender identity and gender expression may differ. There may also be
people who do not present in the binary or masculine or feminine roles, presenting as an alternate
gender, such as genderqueer.
