Ambulatory Care Test Health Equity, Cultural Humility and Social Determinants of Health 5 — Questions and Answers
Question 1: A patient declines a blood transfusion for religious reasons. The nurse's best response is to:
- Notify security
- Respect the decision, ensure informed refusal is documented, and explore acceptable alternatives (Correct answer)
- Try to persuade the patient by explaining the risks repeatedly
- Proceed with transfusion if the patient becomes unconscious
Correct answer: Respect the decision, ensure informed refusal is documented, and explore acceptable alternatives
Competent adults may refuse treatment; nurses document informed refusal and explore acceptable alternatives.
Question 2: Which explanatory model question (Kleinman) best elicits a patient's cultural understanding of illness?
- "Are you allergic to any medications?"
- "Which pharmacy do you use?"
- "What do you think caused your problem?" (Correct answer)
- "What is your insurance carrier?"
Correct answer: "What do you think caused your problem?"
Kleinman's questions explore the patient's beliefs about cause, meaning, and treatment of illness.
Question 3: An older rural patient has no broadband internet and is told to use a telehealth video visit. Which SDOH barrier is present?
- Low health literacy
- Language discordance
- Implicit bias
- Digital divide limiting access to care (Correct answer)
Correct answer: Digital divide limiting access to care
Lack of broadband or devices is the digital divide, which is now recognized as a determinant of health care access.
Question 4: What is the best alternative care option for the patient lacking broadband?
- Offer an audio-only telephone visit or in-person appointment (Correct answer)
- Cancel follow-up until internet is available
- Send all results by patient portal only
- Require the patient to visit a library for video
Correct answer: Offer an audio-only telephone visit or in-person appointment
Audio-only or in-person options preserve access when video is not feasible.
Question 5: Which statement about the impact of social determinants on health outcomes is most accurate?
- Clinical care accounts for most variation in health outcomes
- Social, economic, and environmental factors account for a larger share of health outcomes than clinical care (Correct answer)
- Genetics explains nearly all health outcome differences
- SDOH affect only low-income populations
Correct answer: Social, economic, and environmental factors account for a larger share of health outcomes than clinical care
Research estimates clinical care contributes about 10-20% of outcomes, with social, economic, and behavioral factors contributing more.
Question 6: A Deaf patient who uses American Sign Language arrives for a visit. Under the ADA, the clinic should:
- Communicate through handwritten notes for all discussions
- Charge the patient for interpreter services
- Provide a qualified ASL interpreter at no cost to the patient (Correct answer)
- Ask the patient to bring a family member to interpret
Correct answer: Provide a qualified ASL interpreter at no cost to the patient
The ADA requires effective communication, including qualified ASL interpreters at no cost, for complex discussions.
Question 7: Trauma-informed care in ambulatory settings emphasizes which principle?
- Referring all trauma survivors to psychiatry
- Limiting patient choices to reduce anxiety
- Requiring patients to disclose trauma history at every visit
- Safety, trustworthiness, choice, collaboration, and empowerment (Correct answer)
Correct answer: Safety, trustworthiness, choice, collaboration, and empowerment
SAMHSA's trauma-informed principles include safety, trustworthiness, choice, collaboration, and empowerment.
