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 34-year-old woman reports that her mother was diagnosed
with early-onset Alzheimer disease at 62 and a maternal aunt
had dementia in her late 50s. She is asymptomatic but worries
about risk for her two young children. On exam her mini-cog is
5/5 and vitals are normal. How should the nurse prioritize
counseling and next steps?
Page 1 of 985
,Options
A. Recommend immediate genetic testing for presymptomatic
deterministic mutations and refer to neurology.
B. Explain multifactorial risk, obtain a three-generation
pedigree, and offer discussion of genetic counseling for familial
risk assessment.
C. Reassure her that family history alone is not meaningful and
no further action is needed.
D. Start cholinesterase inhibitor prophylaxis given positive
family history.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes gathering a three-generation
family history and explaining gene–environment and
multifactorial risks; referral to genetic counseling supports
informed decision-making and is the evidence-based next step
for assessing familial risk. This fits safety by preventing
unnecessary interventions and supporting patient autonomy.
A: Immediate presymptomatic genetic testing is premature
without pedigree analysis and genetic counseling; deterministic
mutations are rare and testing requires informed consent and
counseling.
C: Dismissing the history is unsafe; a meaningful family pattern
warrants evaluation per Jarvis’ framework.
Page 2 of 985
,D: Pharmacologic prevention without diagnosis or evidence is
inappropriate and outside assessment scope.
Teaching Point
Obtain a 3-generation pedigree and offer genetic counseling
before testing.
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 27-year-old male construction worker presents with chronic
cough. He reports a paternal uncle with “black lung” and recalls
heavy childhood secondhand smoke exposure. Chest
auscultation is clear; oxygen saturation 98% on room air. Which
interpretation best integrates genetics and environment?
Options
A. Occupational exposure is the only relevant factor; genetic
history is irrelevant.
B. Family history of pneumoconiosis suggests an inherited
susceptibility; prioritize genetic testing for lung fibrosis genes.
C. Consider both environmental exposures (work and
Page 3 of 985
, secondhand smoke) and family history when assessing
cumulative risk and recommend spirometry plus workplace
hazard assessment.
D. Reassure and attribute cough to seasonal allergies; no
further assessment.
Correct Answer
C
Rationales
Correct (C): Jarvis stresses the interaction of genetics and
environment; practical assessment requires objective
pulmonary testing (spirometry) and evaluation of workplace
exposures to identify modifiable risks and guide interventions.
A: Ignoring family history contradicts Jarvis’ biopsychosocial
approach—both factors inform risk.
B: Presuming a monogenic susceptibility and pursuing genetic
testing for lung fibrosis without clinical indicators is premature
and not supported by routine assessment recommendations.
D: Dismissing symptoms without objective testing delays
detection of occupational lung disease.
Teaching Point
Integrate family history with exposure assessment; order
spirometry for chronic cough with occupational risk.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Page 4 of 985
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 34-year-old woman reports that her mother was diagnosed
with early-onset Alzheimer disease at 62 and a maternal aunt
had dementia in her late 50s. She is asymptomatic but worries
about risk for her two young children. On exam her mini-cog is
5/5 and vitals are normal. How should the nurse prioritize
counseling and next steps?
Page 1 of 985
,Options
A. Recommend immediate genetic testing for presymptomatic
deterministic mutations and refer to neurology.
B. Explain multifactorial risk, obtain a three-generation
pedigree, and offer discussion of genetic counseling for familial
risk assessment.
C. Reassure her that family history alone is not meaningful and
no further action is needed.
D. Start cholinesterase inhibitor prophylaxis given positive
family history.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes gathering a three-generation
family history and explaining gene–environment and
multifactorial risks; referral to genetic counseling supports
informed decision-making and is the evidence-based next step
for assessing familial risk. This fits safety by preventing
unnecessary interventions and supporting patient autonomy.
A: Immediate presymptomatic genetic testing is premature
without pedigree analysis and genetic counseling; deterministic
mutations are rare and testing requires informed consent and
counseling.
C: Dismissing the history is unsafe; a meaningful family pattern
warrants evaluation per Jarvis’ framework.
Page 2 of 985
,D: Pharmacologic prevention without diagnosis or evidence is
inappropriate and outside assessment scope.
Teaching Point
Obtain a 3-generation pedigree and offer genetic counseling
before testing.
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 27-year-old male construction worker presents with chronic
cough. He reports a paternal uncle with “black lung” and recalls
heavy childhood secondhand smoke exposure. Chest
auscultation is clear; oxygen saturation 98% on room air. Which
interpretation best integrates genetics and environment?
Options
A. Occupational exposure is the only relevant factor; genetic
history is irrelevant.
B. Family history of pneumoconiosis suggests an inherited
susceptibility; prioritize genetic testing for lung fibrosis genes.
C. Consider both environmental exposures (work and
Page 3 of 985
, secondhand smoke) and family history when assessing
cumulative risk and recommend spirometry plus workplace
hazard assessment.
D. Reassure and attribute cough to seasonal allergies; no
further assessment.
Correct Answer
C
Rationales
Correct (C): Jarvis stresses the interaction of genetics and
environment; practical assessment requires objective
pulmonary testing (spirometry) and evaluation of workplace
exposures to identify modifiable risks and guide interventions.
A: Ignoring family history contradicts Jarvis’ biopsychosocial
approach—both factors inform risk.
B: Presuming a monogenic susceptibility and pursuing genetic
testing for lung fibrosis without clinical indicators is premature
and not supported by routine assessment recommendations.
D: Dismissing symptoms without objective testing delays
detection of occupational lung disease.
Teaching Point
Integrate family history with exposure assessment; order
spirometry for chronic cough with occupational risk.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Page 4 of 985
