PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 32-year-old woman presents for a well visit. She
reports a family history of early-onset coronary artery disease
(father had MI at 44). Her BMI is 31, BP 138/86, and LDL 160
mg/dL (from last lab). You note she smokes half a pack/day.
Which step best applies evidence-based genetic/environmental
risk assessment for her cardiovascular risk?
A. Order comprehensive genetic testing for familial
hypercholesterolemia immediately.
B. Construct a three-generation pedigree and combine family
Page 1 of 981
,history with modifiable risk counseling.
C. Reassure her that lifestyle changes alone will offset her
familial risk; schedule follow-up in one year.
D. Prescribe high-intensity statin therapy without further
history because LDL is high.
Correct Answer: B
Rationale — Correct (B): Jarvis emphasizes combining a focused
family history/pedigree with environmental risk factors to
stratify risk. A three-generation pedigree helps identify possible
familial hypercholesterolemia patterns while allowing
immediate counseling on smoking, weight, and BP — an
evidence-based, safety-focused approach. This integrates
genetic risk with modifiable factors before invasive tests or
medications.
Rationale — Incorrect (A): Genetic testing may be considered if
pedigree suggests an autosomal dominant disorder, but not as
the first step without detailed family history and risk
stratification.
Rationale — Incorrect (C): Reassurance alone ignores current
abnormal labs and modifiable risks and delays appropriate
prevention.
Rationale — Incorrect (D): Statin therapy may be indicated, but
initiating medication without integrating pedigree, shared
decision-making, and confirming secondary causes is
premature.
Page 2 of 981
,Teaching point: Start with a three-generation family history and
address modifiable risks immediately.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A newborn’s mother reports occupational exposure to
organic solvents during pregnancy. The infant appears jittery
and has a low birth weight. Which assessment priority best
reflects evidence-based consideration of gene–environment
interactions?
A. Attribute the infant’s signs solely to prematurity and
discharge on schedule.
B. Document detailed prenatal exposure history and perform
focused neurodevelopmental screening.
C. Order immediate genetic sequencing to rule out inborn
errors of metabolism.
D. Advise the mother there is no known link between solvents
and neonatal outcomes.
Correct Answer: B
Rationale — Correct (B): Jarvis highlights taking exposure
histories and recognizing environmental teratogens' potential
impacts, plus early screening for neurodevelopmental issues
Page 3 of 981
, when exposures occurred. Documenting exposures and
arranging targeted assessments aligns with evidence-based
surveillance for gene–environment effects.
Rationale — Incorrect (A): Solely attributing findings to
prematurity ignores specific exposure risks and misses early
intervention opportunities.
Rationale — Incorrect (C): Genetic sequencing isn't the
immediate first step absent syndrome features; exposure
history and targeted screening are prioritized.
Rationale — Incorrect (D): Dismissing known risks is unsafe;
solvents have documented teratogenic/neurobehavioral
associations in some contexts.
Teaching point: Exposure histories in pregnancy prompt early
targeted developmental screening.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 45-year-old man reports that three first-degree
relatives had colon cancer before age 50. He has no GI
symptoms. Which next step best applies evidence-based
genetic risk assessment?
Page 4 of 981
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 32-year-old woman presents for a well visit. She
reports a family history of early-onset coronary artery disease
(father had MI at 44). Her BMI is 31, BP 138/86, and LDL 160
mg/dL (from last lab). You note she smokes half a pack/day.
Which step best applies evidence-based genetic/environmental
risk assessment for her cardiovascular risk?
A. Order comprehensive genetic testing for familial
hypercholesterolemia immediately.
B. Construct a three-generation pedigree and combine family
Page 1 of 981
,history with modifiable risk counseling.
C. Reassure her that lifestyle changes alone will offset her
familial risk; schedule follow-up in one year.
D. Prescribe high-intensity statin therapy without further
history because LDL is high.
Correct Answer: B
Rationale — Correct (B): Jarvis emphasizes combining a focused
family history/pedigree with environmental risk factors to
stratify risk. A three-generation pedigree helps identify possible
familial hypercholesterolemia patterns while allowing
immediate counseling on smoking, weight, and BP — an
evidence-based, safety-focused approach. This integrates
genetic risk with modifiable factors before invasive tests or
medications.
Rationale — Incorrect (A): Genetic testing may be considered if
pedigree suggests an autosomal dominant disorder, but not as
the first step without detailed family history and risk
stratification.
Rationale — Incorrect (C): Reassurance alone ignores current
abnormal labs and modifiable risks and delays appropriate
prevention.
Rationale — Incorrect (D): Statin therapy may be indicated, but
initiating medication without integrating pedigree, shared
decision-making, and confirming secondary causes is
premature.
Page 2 of 981
,Teaching point: Start with a three-generation family history and
address modifiable risks immediately.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A newborn’s mother reports occupational exposure to
organic solvents during pregnancy. The infant appears jittery
and has a low birth weight. Which assessment priority best
reflects evidence-based consideration of gene–environment
interactions?
A. Attribute the infant’s signs solely to prematurity and
discharge on schedule.
B. Document detailed prenatal exposure history and perform
focused neurodevelopmental screening.
C. Order immediate genetic sequencing to rule out inborn
errors of metabolism.
D. Advise the mother there is no known link between solvents
and neonatal outcomes.
Correct Answer: B
Rationale — Correct (B): Jarvis highlights taking exposure
histories and recognizing environmental teratogens' potential
impacts, plus early screening for neurodevelopmental issues
Page 3 of 981
, when exposures occurred. Documenting exposures and
arranging targeted assessments aligns with evidence-based
surveillance for gene–environment effects.
Rationale — Incorrect (A): Solely attributing findings to
prematurity ignores specific exposure risks and misses early
intervention opportunities.
Rationale — Incorrect (C): Genetic sequencing isn't the
immediate first step absent syndrome features; exposure
history and targeted screening are prioritized.
Rationale — Incorrect (D): Dismissing known risks is unsafe;
solvents have documented teratogenic/neurobehavioral
associations in some contexts.
Teaching point: Exposure histories in pregnancy prompt early
targeted developmental screening.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3.
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 45-year-old man reports that three first-degree
relatives had colon cancer before age 50. He has no GI
symptoms. Which next step best applies evidence-based
genetic risk assessment?
Page 4 of 981
