PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Family History Risk Assessment
Stem: A 38-year-old woman presents for a routine visit. Her
mother was diagnosed with breast cancer at 52 and a maternal
aunt had ovarian cancer at 60. She is anxious and asks whether
she is at high risk and what screening is appropriate. On exam
she is well and vitals normal. Which initial action best aligns
with evidence-based genetic risk assessment?
A. Refer immediately for BRCA1/2 genetic testing.
B. Obtain a three-generation pedigree and calculate her familial
risk.
Page 1 of 978
,C. Reassure her that her risk is average and advise routine
screening only.
D. Order a bilateral mammogram today regardless of screening
interval.
Correct Answer: B
Rationale — Correct: Constructing a three-generation pedigree
is the fundamental first step in evidence-based genetic risk
assessment; it clarifies patterns, degree of relatedness, and
informs need for targeted testing or referral. This follows Jarvis’
guidance to use family history to stratify risk before molecular
testing.
Rationale — A: Immediate BRCA testing is premature without
documented pattern of hereditary cancer risk; testing should be
targeted based on pedigree and counseling.
Rationale — C: Reassurance without assessment risks missing a
hereditary pattern; family history of breast/ovarian cancer
raises concern and needs evaluation.
Rationale — D: Mammography decisions depend on age, risk
level, and screening guidelines; ordering without risk
stratification may lead to unnecessary interventions.
Teaching point: Always start with a three-generation family
history to stratify genetic risk.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
Page 2 of 978
,2
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Environmental Exposures & Reproductive Risk
Stem: A 26-year-old pregnant patient (8 weeks) reports she
works in a nail salon and was recently exposed to strong
solvents. She is worried about fetal harm. Vitals and exam are
normal. Which is the most appropriate immediate response?
A. Tell her the exposure is harmless and no further action is
needed.
B. Recommend termination because first-trimester exposure is
teratogenic.
C. Conduct a targeted exposure history and advise mitigation
steps plus notify her obstetric provider.
D. Order a fetal ultrasound now to detect exposure effects.
Correct Answer: C
Rationale — Correct: Jarvis emphasizes targeted environmental
histories and risk mitigation; for pregnant patients, identify
specific agents, exposure level, and provide immediate practical
actions and coordination with obstetric care. This balances
safety and evidence.
Rationale — A: Minimizing concerns without assessment
neglects potential teratogenic risks and patient anxiety.
Rationale — B: Advising termination based on single exposure,
without data or counseling, is inappropriate and not evidence-
based.
Rationale — D: First-trimester ultrasound cannot detect many
Page 3 of 978
, teratogenic effects and ordering one reflexively is unnecessary;
prioritize exposure assessment and counseling.
Teaching point: Take a focused exposure history and coordinate
mitigation with obstetric care.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Multifactorial Inheritance & Common
Conditions
Stem: A 45-year-old man with obesity and family history of type
2 diabetes (father and paternal grandmother) asks why he
developed impaired fasting glucose. He exercises intermittently.
Which explanation best interprets his risk using a gene–
environment framework?
A. His diabetes is entirely genetic and inevitable.
B. Lifestyle factors interact with polygenic predisposition to
increase disease risk.
C. A single gene mutation caused his glucose disorder.
D. Environmental factors alone cause his condition; genetics
play no role.
Correct Answer: B
Rationale — Correct: Jarvis describes multifactorial inheritance:
common chronic diseases often result from polygenic
Page 4 of 978
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Family History Risk Assessment
Stem: A 38-year-old woman presents for a routine visit. Her
mother was diagnosed with breast cancer at 52 and a maternal
aunt had ovarian cancer at 60. She is anxious and asks whether
she is at high risk and what screening is appropriate. On exam
she is well and vitals normal. Which initial action best aligns
with evidence-based genetic risk assessment?
A. Refer immediately for BRCA1/2 genetic testing.
B. Obtain a three-generation pedigree and calculate her familial
risk.
Page 1 of 978
,C. Reassure her that her risk is average and advise routine
screening only.
D. Order a bilateral mammogram today regardless of screening
interval.
Correct Answer: B
Rationale — Correct: Constructing a three-generation pedigree
is the fundamental first step in evidence-based genetic risk
assessment; it clarifies patterns, degree of relatedness, and
informs need for targeted testing or referral. This follows Jarvis’
guidance to use family history to stratify risk before molecular
testing.
Rationale — A: Immediate BRCA testing is premature without
documented pattern of hereditary cancer risk; testing should be
targeted based on pedigree and counseling.
Rationale — C: Reassurance without assessment risks missing a
hereditary pattern; family history of breast/ovarian cancer
raises concern and needs evaluation.
Rationale — D: Mammography decisions depend on age, risk
level, and screening guidelines; ordering without risk
stratification may lead to unnecessary interventions.
Teaching point: Always start with a three-generation family
history to stratify genetic risk.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
Page 2 of 978
,2
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Environmental Exposures & Reproductive Risk
Stem: A 26-year-old pregnant patient (8 weeks) reports she
works in a nail salon and was recently exposed to strong
solvents. She is worried about fetal harm. Vitals and exam are
normal. Which is the most appropriate immediate response?
A. Tell her the exposure is harmless and no further action is
needed.
B. Recommend termination because first-trimester exposure is
teratogenic.
C. Conduct a targeted exposure history and advise mitigation
steps plus notify her obstetric provider.
D. Order a fetal ultrasound now to detect exposure effects.
Correct Answer: C
Rationale — Correct: Jarvis emphasizes targeted environmental
histories and risk mitigation; for pregnant patients, identify
specific agents, exposure level, and provide immediate practical
actions and coordination with obstetric care. This balances
safety and evidence.
Rationale — A: Minimizing concerns without assessment
neglects potential teratogenic risks and patient anxiety.
Rationale — B: Advising termination based on single exposure,
without data or counseling, is inappropriate and not evidence-
based.
Rationale — D: First-trimester ultrasound cannot detect many
Page 3 of 978
, teratogenic effects and ordering one reflexively is unnecessary;
prioritize exposure assessment and counseling.
Teaching point: Take a focused exposure history and coordinate
mitigation with obstetric care.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Genetics &
Environment — Multifactorial Inheritance & Common
Conditions
Stem: A 45-year-old man with obesity and family history of type
2 diabetes (father and paternal grandmother) asks why he
developed impaired fasting glucose. He exercises intermittently.
Which explanation best interprets his risk using a gene–
environment framework?
A. His diabetes is entirely genetic and inevitable.
B. Lifestyle factors interact with polygenic predisposition to
increase disease risk.
C. A single gene mutation caused his glucose disorder.
D. Environmental factors alone cause his condition; genetics
play no role.
Correct Answer: B
Rationale — Correct: Jarvis describes multifactorial inheritance:
common chronic diseases often result from polygenic
Page 4 of 978
