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 29-year-old G1P0 woman arrives for a preconception visit.
She reports her mother had "early" coronary artery disease at
age 45, and two maternal uncles had heart attacks in their 40s;
her BMI is 31 and she smokes 1 pack/day. Family history
suggests clustered early cardiovascular events; you observe no
murmur and her blood pressure is 128/78 mm Hg.
Page 1 of 987
,Options
A. Reassure and provide routine prenatal counseling; her
findings are low risk.
B. Order baseline lipid panel and counsel on modifiable risk
factors; consider early cardiology referral if abnormal.
C. Recommend immediate genetic testing for familial
hypercholesterolemia (FH) without labs.
D. Advise pregnancy delay and start high-intensity statin
therapy now.
Correct Answer
B
Rationale — Correct (B)
Jarvis emphasizes three-generation family history and
identification of red flags (multiple early cardiovascular events).
Ordering baseline lipids and counseling on smoking cessation,
weight loss, and timing of pregnancy addresses modifiable risks
and helps decide need for genetic testing or specialist referral
— an evidence-based, safety-focused next step. This approach
balances evaluation and risk reduction before pregnancy.
Rationale — Incorrect
A. Reassurance alone ignores clustered early events (red flag)
and missed opportunity for prevention.
C. Genetic testing for FH may be indicated but should follow
phenotypic screening (lipids) and counseling; immediate testing
without labs is premature.
D. Starting high-intensity statin preconception without full
Page 2 of 987
,evaluation is unnecessary and potentially teratogenic if
pregnancy occurs; first optimize lifestyle and labs.
Teaching Point
Three-generation family history + targeted labs guides genetic
referral and prevention.
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 46-year-old man reports progressive memory lapses and that
his father was diagnosed with dementia at age 62. He works as
a mechanic and reports chronic solvent exposure. Neurologic
exam shows intact cranial nerves but slowed executive tasks on
bedside testing. You must weigh family risk against
environmental exposures.
Options
A. Attribute symptoms to occupational solvent exposure and
advise workplace change only.
B. Recommend a focused cognitive assessment, occupational
exposure history, and consider genetic counseling for familial
Page 3 of 987
, dementia.
C. Diagnose early Alzheimer disease now and start
cholinesterase inhibitor therapy.
D. Reassure him that at age 46, cognitive changes are normal
and schedule routine follow-up in a year.
Correct Answer
B
Rationale — Correct (B)
Jarvis highlights integrating family history with environmental
risk factors. A focused cognitive evaluation (formal testing),
detailed occupational exposure assessment, and discussion
about family risk/genetic counseling synthesize causes and
guide targeted workup and safety interventions.
Rationale — Incorrect
A. Ignoring family history risks missing hereditary contributions;
solvents may contribute but need evaluation.
C. Initiating treatment without diagnostic confirmation is
premature and could cause harm.
D. Minimizing symptoms risks delayed diagnosis of treatable or
progressive conditions.
Teaching Point
Combine focused cognitive testing, occupational exposure
assessment, and genetic risk evaluation.
Page 4 of 987
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 29-year-old G1P0 woman arrives for a preconception visit.
She reports her mother had "early" coronary artery disease at
age 45, and two maternal uncles had heart attacks in their 40s;
her BMI is 31 and she smokes 1 pack/day. Family history
suggests clustered early cardiovascular events; you observe no
murmur and her blood pressure is 128/78 mm Hg.
Page 1 of 987
,Options
A. Reassure and provide routine prenatal counseling; her
findings are low risk.
B. Order baseline lipid panel and counsel on modifiable risk
factors; consider early cardiology referral if abnormal.
C. Recommend immediate genetic testing for familial
hypercholesterolemia (FH) without labs.
D. Advise pregnancy delay and start high-intensity statin
therapy now.
Correct Answer
B
Rationale — Correct (B)
Jarvis emphasizes three-generation family history and
identification of red flags (multiple early cardiovascular events).
Ordering baseline lipids and counseling on smoking cessation,
weight loss, and timing of pregnancy addresses modifiable risks
and helps decide need for genetic testing or specialist referral
— an evidence-based, safety-focused next step. This approach
balances evaluation and risk reduction before pregnancy.
Rationale — Incorrect
A. Reassurance alone ignores clustered early events (red flag)
and missed opportunity for prevention.
C. Genetic testing for FH may be indicated but should follow
phenotypic screening (lipids) and counseling; immediate testing
without labs is premature.
D. Starting high-intensity statin preconception without full
Page 2 of 987
,evaluation is unnecessary and potentially teratogenic if
pregnancy occurs; first optimize lifestyle and labs.
Teaching Point
Three-generation family history + targeted labs guides genetic
referral and prevention.
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 46-year-old man reports progressive memory lapses and that
his father was diagnosed with dementia at age 62. He works as
a mechanic and reports chronic solvent exposure. Neurologic
exam shows intact cranial nerves but slowed executive tasks on
bedside testing. You must weigh family risk against
environmental exposures.
Options
A. Attribute symptoms to occupational solvent exposure and
advise workplace change only.
B. Recommend a focused cognitive assessment, occupational
exposure history, and consider genetic counseling for familial
Page 3 of 987
, dementia.
C. Diagnose early Alzheimer disease now and start
cholinesterase inhibitor therapy.
D. Reassure him that at age 46, cognitive changes are normal
and schedule routine follow-up in a year.
Correct Answer
B
Rationale — Correct (B)
Jarvis highlights integrating family history with environmental
risk factors. A focused cognitive evaluation (formal testing),
detailed occupational exposure assessment, and discussion
about family risk/genetic counseling synthesize causes and
guide targeted workup and safety interventions.
Rationale — Incorrect
A. Ignoring family history risks missing hereditary contributions;
solvents may contribute but need evaluation.
C. Initiating treatment without diagnostic confirmation is
premature and could cause harm.
D. Minimizing symptoms risks delayed diagnosis of treatable or
progressive conditions.
Teaching Point
Combine focused cognitive testing, occupational exposure
assessment, and genetic risk evaluation.
Page 4 of 987
