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 28-year-old woman presents for a well visit. She reports her
mother and maternal aunt had early-onset breast cancer (both
in their 40s). She is otherwise healthy and asks whether she
should have genetic testing now. You note no personal breast
findings on exam. How should you counsel her regarding next
steps?
Page 1 of 985
,Options
A. Recommend immediate BRCA genetic testing because of two
family members with breast cancer.
B. Take a three-generation pedigree and refer for genetic
counseling to evaluate testing appropriateness.
C. Reassure that without a personal cancer diagnosis, genetic
testing is unnecessary.
D. Order mammography now and postpone any genetic
discussion until results return.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes using family history (three-
generation pedigree) to assess genetic risk before testing;
referral to genetic counseling ensures appropriate risk
stratification, informed consent, and interpretation—critical for
safe, evidence-based decision making.
A: Testing without structured pedigree assessment can lead to
unnecessary testing and misinterpretation; family pattern
(maternal lineage, ages, other cancers) must be clarified first.
C: Dismissing testing outright ignores significant family
clustering and misses the need for risk evaluation; Jarvis
stresses individualized assessment.
D: Mammography may be part of screening but does not
replace genetic risk assessment; ordering imaging before
Page 2 of 985
,pedigree/genetic counseling may delay appropriate risk
management decisions.
Teaching point
Obtain a three-generation pedigree and refer to genetic
counseling before ordering genetic tests.
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 6-year-old boy is brought for developmental delay. His
parents ask whether environmental exposures could explain his
delayed speech. You learn they live in an older home with
peeling paint and use a backyard well. Which initial assessment
step best prioritizes safety and diagnostic yield?
Options
A. Order an MRI of the brain to look for structural causes.
B. Screen the child for blood lead level and obtain a focused
environmental history.
C. Refer for speech therapy and reassess in 6 months.
Page 3 of 985
, D. Assume developmental variation; advise enrichment
activities at home.
Correct answer
B
Rationales
Correct (B): Jarvis highlights targeted environmental history and
screening when exposures are plausible; lead exposure is a
modifiable, high-risk cause of developmental delay—blood lead
testing is a priority for safety and treatment.
A: Neuroimaging is not first-line for developmental delay
without focal neurologic signs; it’s less efficient and may delay
addressing environmental risks.
C: While therapy is important, delaying exposure assessment
risks ongoing neurotoxic exposure; screening should occur
concurrently.
D: Minimizing parental concerns without objective screening
misses a possible reversible cause; Jarvis advocates evidence-
based assessment of environment.
Teaching point
Suspect lead exposure with old housing and developmental
delay; obtain blood lead testing promptly.
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 28-year-old woman presents for a well visit. She reports her
mother and maternal aunt had early-onset breast cancer (both
in their 40s). She is otherwise healthy and asks whether she
should have genetic testing now. You note no personal breast
findings on exam. How should you counsel her regarding next
steps?
Page 1 of 985
,Options
A. Recommend immediate BRCA genetic testing because of two
family members with breast cancer.
B. Take a three-generation pedigree and refer for genetic
counseling to evaluate testing appropriateness.
C. Reassure that without a personal cancer diagnosis, genetic
testing is unnecessary.
D. Order mammography now and postpone any genetic
discussion until results return.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes using family history (three-
generation pedigree) to assess genetic risk before testing;
referral to genetic counseling ensures appropriate risk
stratification, informed consent, and interpretation—critical for
safe, evidence-based decision making.
A: Testing without structured pedigree assessment can lead to
unnecessary testing and misinterpretation; family pattern
(maternal lineage, ages, other cancers) must be clarified first.
C: Dismissing testing outright ignores significant family
clustering and misses the need for risk evaluation; Jarvis
stresses individualized assessment.
D: Mammography may be part of screening but does not
replace genetic risk assessment; ordering imaging before
Page 2 of 985
,pedigree/genetic counseling may delay appropriate risk
management decisions.
Teaching point
Obtain a three-generation pedigree and refer to genetic
counseling before ordering genetic tests.
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 6-year-old boy is brought for developmental delay. His
parents ask whether environmental exposures could explain his
delayed speech. You learn they live in an older home with
peeling paint and use a backyard well. Which initial assessment
step best prioritizes safety and diagnostic yield?
Options
A. Order an MRI of the brain to look for structural causes.
B. Screen the child for blood lead level and obtain a focused
environmental history.
C. Refer for speech therapy and reassess in 6 months.
Page 3 of 985
, D. Assume developmental variation; advise enrichment
activities at home.
Correct answer
B
Rationales
Correct (B): Jarvis highlights targeted environmental history and
screening when exposures are plausible; lead exposure is a
modifiable, high-risk cause of developmental delay—blood lead
testing is a priority for safety and treatment.
A: Neuroimaging is not first-line for developmental delay
without focal neurologic signs; it’s less efficient and may delay
addressing environmental risks.
C: While therapy is important, delaying exposure assessment
risks ongoing neurotoxic exposure; screening should occur
concurrently.
D: Minimizing parental concerns without objective screening
misses a possible reversible cause; Jarvis advocates evidence-
based assessment of environment.
Teaching point
Suspect lead exposure with old housing and developmental
delay; obtain blood lead testing promptly.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Page 4 of 985
