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 & Levels of Evidence
Stem: A 55-year-old woman presents for an annual exam and
asks whether the clinician should order an imaging study she
read about online. Her history is noncontributory and physical
exam is normal. You must decide whether to order the test
now. Which approach best follows Jarvis’ evidence-based
assessment framework for deciding on a screening or diagnostic
test in an asymptomatic patient?
Page 1 of 981
,A. Order the imaging because a negative exam doesn't exclude
subclinical disease, and patient preference drives screening.
B. Defer testing and use population-based screening guidelines
and evidence hierarchy to assess benefit versus harm first.
C. Order the imaging only if the test is low cost and low risk,
since harm is minimal.
D. Refer immediately for specialist testing because imaging is
more sensitive than clinical examination.
Correct Answer: B
Rationales:
Correct (B): Jarvis emphasizes using evidence hierarchies and
guideline-based screening thresholds to weigh benefits and
harms before testing. For asymptomatic patients, clinicians
should appraise population-level evidence and pretest
probability to avoid unnecessary tests and harms. This
approach supports safe, cost-effective practice and clinical
judgment.
A: Patient preference is important but should not override
evidence when screening yields net harm or uncertain benefit;
Jarvis stresses shared decision-making guided by evidence, not
preference alone.
C: Low cost/low risk alone does not justify screening unless
evidence demonstrates net benefit; Jarvis warns against “just
because” testing.
D: Referral/testing because of perceived sensitivity ignores
Page 2 of 981
,pretest probability and guideline recommendations—Jarvis
prioritizes evidence before escalation.
Teaching point: Use guideline-based evidence and pretest
probability before ordering screening tests.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Evidence-Based Assessment — Validity &
Reliability of Assessment Tools
Stem: You are evaluating a new pain-assessment tool for use in
your clinic. The tool produces consistent scores when repeated,
but scores do not correlate well with patients’ reported pain
scores. According to Jarvis, how should you interpret these
psychometric findings?
A. The tool is both valid and reliable; adopt it because
repeatability is most important.
B. The tool is reliable but lacks validity; do not rely on it as the
sole pain measure.
C. The tool is invalid but reliable; however, validity is not
necessary if staff prefer it.
D. The tool should be discarded because reliability without
validity is impossible.
Correct Answer: B
Page 3 of 981
, Rationales:
Correct (B): Jarvis distinguishes reliability (consistency) from
validity (measuring what it intends). A tool can be reliable yet
not valid; therefore it should not be used as the sole measure
for clinical decisions about pain.
A: Repeatability alone does not ensure the tool measures true
pain (validity). Jarvis advises both properties are needed.
C: Validity is essential for clinical decisions; staff preference
cannot replace evidence of validity per Jarvis’ framework.
D: Reliability without validity is possible and meaningful to
recognize; discarding without further evaluation is not
warranted.
Teaching point: Reliability ≠ validity; both are required for
clinical decision making.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Clinical
Practice Guidelines & Shared Decision-Making
Stem: A 46-year-old man with a family history of colorectal
cancer asks about earlier colonoscopy. He is asymptomatic and
has average health otherwise. Using Jarvis’ recommendations,
which next step aligns best with evidence-based, patient-
centered assessment?
Page 4 of 981
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Clinical
Decision-Making & Levels of Evidence
Stem: A 55-year-old woman presents for an annual exam and
asks whether the clinician should order an imaging study she
read about online. Her history is noncontributory and physical
exam is normal. You must decide whether to order the test
now. Which approach best follows Jarvis’ evidence-based
assessment framework for deciding on a screening or diagnostic
test in an asymptomatic patient?
Page 1 of 981
,A. Order the imaging because a negative exam doesn't exclude
subclinical disease, and patient preference drives screening.
B. Defer testing and use population-based screening guidelines
and evidence hierarchy to assess benefit versus harm first.
C. Order the imaging only if the test is low cost and low risk,
since harm is minimal.
D. Refer immediately for specialist testing because imaging is
more sensitive than clinical examination.
Correct Answer: B
Rationales:
Correct (B): Jarvis emphasizes using evidence hierarchies and
guideline-based screening thresholds to weigh benefits and
harms before testing. For asymptomatic patients, clinicians
should appraise population-level evidence and pretest
probability to avoid unnecessary tests and harms. This
approach supports safe, cost-effective practice and clinical
judgment.
A: Patient preference is important but should not override
evidence when screening yields net harm or uncertain benefit;
Jarvis stresses shared decision-making guided by evidence, not
preference alone.
C: Low cost/low risk alone does not justify screening unless
evidence demonstrates net benefit; Jarvis warns against “just
because” testing.
D: Referral/testing because of perceived sensitivity ignores
Page 2 of 981
,pretest probability and guideline recommendations—Jarvis
prioritizes evidence before escalation.
Teaching point: Use guideline-based evidence and pretest
probability before ordering screening tests.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Evidence-Based Assessment — Validity &
Reliability of Assessment Tools
Stem: You are evaluating a new pain-assessment tool for use in
your clinic. The tool produces consistent scores when repeated,
but scores do not correlate well with patients’ reported pain
scores. According to Jarvis, how should you interpret these
psychometric findings?
A. The tool is both valid and reliable; adopt it because
repeatability is most important.
B. The tool is reliable but lacks validity; do not rely on it as the
sole pain measure.
C. The tool is invalid but reliable; however, validity is not
necessary if staff prefer it.
D. The tool should be discarded because reliability without
validity is impossible.
Correct Answer: B
Page 3 of 981
, Rationales:
Correct (B): Jarvis distinguishes reliability (consistency) from
validity (measuring what it intends). A tool can be reliable yet
not valid; therefore it should not be used as the sole measure
for clinical decisions about pain.
A: Repeatability alone does not ensure the tool measures true
pain (validity). Jarvis advises both properties are needed.
C: Validity is essential for clinical decisions; staff preference
cannot replace evidence of validity per Jarvis’ framework.
D: Reliability without validity is possible and meaningful to
recognize; discarding without further evaluation is not
warranted.
Teaching point: Reliability ≠ validity; both are required for
clinical decision making.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Clinical
Practice Guidelines & Shared Decision-Making
Stem: A 46-year-old man with a family history of colorectal
cancer asks about earlier colonoscopy. He is asymptomatic and
has average health otherwise. Using Jarvis’ recommendations,
which next step aligns best with evidence-based, patient-
centered assessment?
Page 4 of 981
