PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Formulating
Clinical Questions
Stem: A 68-year-old man presents for an annual exam and asks
whether routine screening for abdominal aortic aneurysm
(AAA) is indicated for him. He is a current smoker with a 45-
pack-year history and a blood pressure of 148/86 mmHg. As an
evidence-based clinician, which next step best applies Jarvis’
approach to clinical questioning?
A. Order an abdominal ultrasound immediately because his
smoking history alone justifies screening.
Page 1 of 981
,B. Frame a focused PICO question: in men aged ≥65 with
smoking history (P), does one-time ultrasound screening (I)
versus no screening (C) reduce mortality (O)?
C. Reassure him and defer screening because his blood pressure
is controlled and he has no abdominal pain.
D. Refer to vascular surgery for prophylactic repair based on risk
factors.
Correct Answer: B
Rationales:
Correct (B): Jarvis’ evidence-based assessment framework
encourages forming a focused clinical question (PICO) to guide
efficient literature search and decision-making; this question
targets population, intervention, comparator, and outcome
before ordering tests. It promotes appropriate use of resources
and reduces unnecessary interventions.
Incorrect (A): Immediate ultrasound without framing the
question ignores pretest probability and guideline-directed
screening criteria; Jarvis advises targeted decision steps before
testing.
Incorrect (C): Reassurance without evaluation of guidelines and
risk misses a potential evidence-based preventive intervention;
Jarvis emphasizes risk stratification.
Incorrect (D): Referral for surgery is premature without
diagnostic confirmation and guideline-based criteria; Jarvis
supports stepwise assessment.
Page 2 of 981
,Teaching Point: Use a focused PICO question to guide screening
decisions.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Evidence-Based Assessment — Test
Characteristics & Pretest Probability
Stem: A 34-year-old woman with a family history of early-onset
breast cancer asks about BRCA testing after a normal clinical
breast exam. Her mother was diagnosed at 42. Which
interpretation best follows Jarvis’ guidance on pretest
probability and diagnostic testing?
A. Because the clinical exam is normal, BRCA testing is not
indicated.
B. Her family history increases pretest probability, so targeted
genetic testing is reasonable despite a normal exam.
C. Order a screening mammogram now and defer genetic
testing until after imaging.
D. Recommend population-based BRCA screening for all women
her age.
Correct Answer: B
Rationales:
Correct (B): Jarvis highlights that family history raises pretest
Page 3 of 981
, probability for genetic conditions; genetic testing is guided by
risk assessment even when the physical exam is normal, since
genetics often precede physical findings.
Incorrect (A): A normal exam does not rule out genetic risk;
Jarvis separates genetic risk assessment from physical exam
sensitivity.
Incorrect (C): While imaging may be appropriate, delaying
genetic assessment ignores the utility of targeted testing
triggered by family history; Jarvis supports parallel risk
evaluation.
Incorrect (D): Universal BRCA screening is not evidence-based
for all women; Jarvis advocates risk-stratified testing.
Teaching Point: Family history raises pretest probability—
consider targeted genetic testing even with normal exam.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Applying
Evidence to the Individual Patient
Stem: During discharge teaching, a 57-year-old male with COPD
asks whether smoking cessation will reduce his exacerbation
risk. He says he’s tried before and is skeptical. Using evidence
application principles, which clinician response best aligns with
Jarvis’ model?
Page 4 of 981
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Formulating
Clinical Questions
Stem: A 68-year-old man presents for an annual exam and asks
whether routine screening for abdominal aortic aneurysm
(AAA) is indicated for him. He is a current smoker with a 45-
pack-year history and a blood pressure of 148/86 mmHg. As an
evidence-based clinician, which next step best applies Jarvis’
approach to clinical questioning?
A. Order an abdominal ultrasound immediately because his
smoking history alone justifies screening.
Page 1 of 981
,B. Frame a focused PICO question: in men aged ≥65 with
smoking history (P), does one-time ultrasound screening (I)
versus no screening (C) reduce mortality (O)?
C. Reassure him and defer screening because his blood pressure
is controlled and he has no abdominal pain.
D. Refer to vascular surgery for prophylactic repair based on risk
factors.
Correct Answer: B
Rationales:
Correct (B): Jarvis’ evidence-based assessment framework
encourages forming a focused clinical question (PICO) to guide
efficient literature search and decision-making; this question
targets population, intervention, comparator, and outcome
before ordering tests. It promotes appropriate use of resources
and reduces unnecessary interventions.
Incorrect (A): Immediate ultrasound without framing the
question ignores pretest probability and guideline-directed
screening criteria; Jarvis advises targeted decision steps before
testing.
Incorrect (C): Reassurance without evaluation of guidelines and
risk misses a potential evidence-based preventive intervention;
Jarvis emphasizes risk stratification.
Incorrect (D): Referral for surgery is premature without
diagnostic confirmation and guideline-based criteria; Jarvis
supports stepwise assessment.
Page 2 of 981
,Teaching Point: Use a focused PICO question to guide screening
decisions.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Evidence-Based Assessment — Test
Characteristics & Pretest Probability
Stem: A 34-year-old woman with a family history of early-onset
breast cancer asks about BRCA testing after a normal clinical
breast exam. Her mother was diagnosed at 42. Which
interpretation best follows Jarvis’ guidance on pretest
probability and diagnostic testing?
A. Because the clinical exam is normal, BRCA testing is not
indicated.
B. Her family history increases pretest probability, so targeted
genetic testing is reasonable despite a normal exam.
C. Order a screening mammogram now and defer genetic
testing until after imaging.
D. Recommend population-based BRCA screening for all women
her age.
Correct Answer: B
Rationales:
Correct (B): Jarvis highlights that family history raises pretest
Page 3 of 981
, probability for genetic conditions; genetic testing is guided by
risk assessment even when the physical exam is normal, since
genetics often precede physical findings.
Incorrect (A): A normal exam does not rule out genetic risk;
Jarvis separates genetic risk assessment from physical exam
sensitivity.
Incorrect (C): While imaging may be appropriate, delaying
genetic assessment ignores the utility of targeted testing
triggered by family history; Jarvis supports parallel risk
evaluation.
Incorrect (D): Universal BRCA screening is not evidence-based
for all women; Jarvis advocates risk-stratified testing.
Teaching Point: Family history raises pretest probability—
consider targeted genetic testing even with normal exam.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Applying
Evidence to the Individual Patient
Stem: During discharge teaching, a 57-year-old male with COPD
asks whether smoking cessation will reduce his exacerbation
risk. He says he’s tried before and is skeptical. Using evidence
application principles, which clinician response best aligns with
Jarvis’ model?
Page 4 of 981
