PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Clinical
Decision Making
Stem: A 68-year-old man reports “forgetting names more often”
over six months but remains independent with ADLs. Mini-cog
yields 1/3 recall and abnormal clock drawing; vitals stable. How
should the nurse practitioner interpret these findings and act
first?
A. Diagnose early Alzheimer disease and start cholinesterase
inhibitor.
B. Consider reversible causes of cognitive impairment and order
Page 1 of 980
,focused labs (TSH, B12, CBC).
C. Reassure patient that age-related forgetfulness is expected
and schedule routine follow-up in 6 months.
D. Refer immediately for MRI brain to confirm
neurodegenerative disease.
Correct Answer: B
Rationale — Correct: Jarvis emphasizes that abnormal cognitive
screening requires evaluation for reversible causes first (thyroid
dysfunction, B12 deficiency, anemia, metabolic derangements).
Ordering focused labs is the priority step for safe clinical
decision-making before labeling progressive dementia.
Rationale — Incorrect A: Jumping to Alzheimer diagnosis and
starting meds without ruling out reversible causes contradicts
evidence-based evaluation.
Rationale — Incorrect C: Dismissing abnormal screening as
normal aging risks missing treatable conditions. Jarvis warns
against attributing pathology to “normal aging.”
Rationale — Incorrect D: MRI may be useful but is not the
immediate first step; lab evaluation and history/medication
review come first per Jarvis’ algorithm.
Teaching Point: Abnormal cognitive screen → evaluate
reversible causes before diagnosing dementia.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
Page 2 of 980
,2
Reference: Ch. 1 — Evidence-Based Assessment — Screening
Tests: Sensitivity & Specificity
Stem: A clinic uses a new screening instrument for depression
with sensitivity 85% and specificity 60%. A 45-year-old woman
screens positive. Which interpretation best guides next steps?
A. The high sensitivity means a positive test confirms major
depression; start antidepressant.
B. Because specificity is low, positive result requires diagnostic
interview to rule out false positives.
C. With these metrics, a negative result would have been more
concerning than a positive one.
D. The test’s sensitivity and specificity indicate it is useless
clinically and should be discarded.
Correct Answer: B
Rationale — Correct: Jarvis teaches that high sensitivity screens
minimize false negatives; low specificity increases false
positives. A positive screen therefore needs a diagnostic
interview to confirm depression before treatment.
Rationale — Incorrect A: Positive screening alone doesn't
confirm diagnosis; treatment decisions require diagnostic
confirmation.
Rationale — Incorrect C: High sensitivity means negative results
are helpful to rule out disease (SNout); positive results still need
confirmation.
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, Rationale — Incorrect D: The tool can be useful as a screen if
followed by appropriate diagnostic assessment; discarding it
outright is premature.
Teaching Point: High sensitivity screens: rule-out tool; positives
need diagnostic confirmation.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Data
Collection & Validity
Stem: During an intake, a 30-year-old trans male reports
smoking 1 pack/day. The intake form lists gender as female and
asks about pregnancy. You observe anxiety and hesitancy.
According to Jarvis’ principles, what is the clinician’s best next
step?
A. Proceed with the standard form questions unchanged to
maintain data validity.
B. Accept the form data as recorded and schedule routine
counseling about smoking cessation.
C. Pause to validate gender identity, clarify reproductive
anatomy, and adapt the assessment respectfully.
D. Reassign the patient to a provider who treats LGBTQ+
patients to avoid discomfort.
Page 4 of 980
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Clinical
Decision Making
Stem: A 68-year-old man reports “forgetting names more often”
over six months but remains independent with ADLs. Mini-cog
yields 1/3 recall and abnormal clock drawing; vitals stable. How
should the nurse practitioner interpret these findings and act
first?
A. Diagnose early Alzheimer disease and start cholinesterase
inhibitor.
B. Consider reversible causes of cognitive impairment and order
Page 1 of 980
,focused labs (TSH, B12, CBC).
C. Reassure patient that age-related forgetfulness is expected
and schedule routine follow-up in 6 months.
D. Refer immediately for MRI brain to confirm
neurodegenerative disease.
Correct Answer: B
Rationale — Correct: Jarvis emphasizes that abnormal cognitive
screening requires evaluation for reversible causes first (thyroid
dysfunction, B12 deficiency, anemia, metabolic derangements).
Ordering focused labs is the priority step for safe clinical
decision-making before labeling progressive dementia.
Rationale — Incorrect A: Jumping to Alzheimer diagnosis and
starting meds without ruling out reversible causes contradicts
evidence-based evaluation.
Rationale — Incorrect C: Dismissing abnormal screening as
normal aging risks missing treatable conditions. Jarvis warns
against attributing pathology to “normal aging.”
Rationale — Incorrect D: MRI may be useful but is not the
immediate first step; lab evaluation and history/medication
review come first per Jarvis’ algorithm.
Teaching Point: Abnormal cognitive screen → evaluate
reversible causes before diagnosing dementia.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
Page 2 of 980
,2
Reference: Ch. 1 — Evidence-Based Assessment — Screening
Tests: Sensitivity & Specificity
Stem: A clinic uses a new screening instrument for depression
with sensitivity 85% and specificity 60%. A 45-year-old woman
screens positive. Which interpretation best guides next steps?
A. The high sensitivity means a positive test confirms major
depression; start antidepressant.
B. Because specificity is low, positive result requires diagnostic
interview to rule out false positives.
C. With these metrics, a negative result would have been more
concerning than a positive one.
D. The test’s sensitivity and specificity indicate it is useless
clinically and should be discarded.
Correct Answer: B
Rationale — Correct: Jarvis teaches that high sensitivity screens
minimize false negatives; low specificity increases false
positives. A positive screen therefore needs a diagnostic
interview to confirm depression before treatment.
Rationale — Incorrect A: Positive screening alone doesn't
confirm diagnosis; treatment decisions require diagnostic
confirmation.
Rationale — Incorrect C: High sensitivity means negative results
are helpful to rule out disease (SNout); positive results still need
confirmation.
Page 3 of 980
, Rationale — Incorrect D: The tool can be useful as a screen if
followed by appropriate diagnostic assessment; discarding it
outright is premature.
Teaching Point: High sensitivity screens: rule-out tool; positives
need diagnostic confirmation.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Data
Collection & Validity
Stem: During an intake, a 30-year-old trans male reports
smoking 1 pack/day. The intake form lists gender as female and
asks about pregnancy. You observe anxiety and hesitancy.
According to Jarvis’ principles, what is the clinician’s best next
step?
A. Proceed with the standard form questions unchanged to
maintain data validity.
B. Accept the form data as recorded and schedule routine
counseling about smoking cessation.
C. Pause to validate gender identity, clarify reproductive
anatomy, and adapt the assessment respectfully.
D. Reassign the patient to a provider who treats LGBTQ+
patients to avoid discomfort.
Page 4 of 980
