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
NCLEX-Level Question Stem (2–4 sentences)
A 28-year-old woman presents for a preconception visit. She
reports a family history of early-onset cardiomyopathy in her
brother (diagnosed at age 32) and two maternal aunts with
sudden cardiac death in their 40s. Her vitals are normal and
cardiac exam reveals a subtle 2/6 systolic murmur heard best at
the left lower sternal border. Which action best addresses the
immediate risk and guides safe prenatal planning?
Page 1 of 985
,A. Reassure the patient; proceed with routine prenatal labs and
standard prenatal counseling.
B. Order an echocardiogram and refer for genetic
counseling/testing for familial cardiac disorders.
C. Send for baseline electrocardiogram (ECG) only and postpone
genetic referral until pregnancy.
D. Begin low-dose beta-blocker prophylaxis and schedule
routine prenatal care.
Correct Answer: B
Rationales
Correct (B): Jarvis emphasizes that a suspicious family history of
early-onset cardiomyopathy and sudden cardiac death warrants
targeted cardiac evaluation and genetic counseling before
pregnancy; an echocardiogram can identify subclinical
structural disease while genetic testing clarifies hereditary risk
and informs reproductive decisions. This approach prioritizes
patient safety and informed prenatal planning.
A: Reassurance alone misses significant red flags (early familial
cardiomyopathy, sudden deaths) and fails to follow Jarvis’
guidance to investigate familial patterns.
C: An ECG may detect arrhythmias but is insufficient alone to
evaluate structural cardiomyopathy risk; delaying genetic
referral risks missed preconception counseling.
D: Initiating beta-blocker therapy without diagnostic
confirmation is inappropriate and may cause harm; therapy
should follow confirmed diagnosis and specialist input.
Page 2 of 985
,Teaching Point: Family patterns of early cardiac disease require
echo + genetic counseling before pregnancy.
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
NCLEX-Level Question Stem (2–4 sentences)
A 54-year-old man reports progressive memory complaints over
2 years; his father was diagnosed with Alzheimer disease at age
78. He lives alone, works full time, and has well controlled
hypertension. Cognitive screening shows mild deficits in short-
term recall. Which interpretation and next step best reflects
evidence-based assessment of genetic and environmental
contributors?
A. Attributing symptoms to normal aging; advise social
engagement and follow up in 12 months.
B. Consider early-onset familial Alzheimer’s syndrome and refer
for immediate genetic testing.
C. Evaluate modifiable environmental contributors (vascular risk
control, sleep, substance exposure) and arrange comprehensive
cognitive assessment.
Page 3 of 985
, D. Start an acetylcholinesterase inhibitor empirically and
schedule neurology referral.
Correct Answer: C
Rationales
Correct (C): Jarvis frames cognitive complaints as
multifactorial—family history increases risk but age and
vascular risk factors are important modifiable contributors.
Comprehensive cognitive testing plus optimization of vascular
health, sleep, and exposures is evidence-based before labeling a
genetic syndrome.
A: Dismissing as normal aging ignores progressive decline and
family history; Jarvis recommends targeted assessment of risks
and function.
B: Immediate genetic testing for familial Alzheimer’s is
premature; familial early-onset syndromes are rare and require
specialist evaluation and counseling.
D: Starting dementia pharmacotherapy without confirmatory
diagnosis and specialist input is premature and not aligned with
safe practice.
Teaching Point: Cognitive decline: assess modifiable
environmental risks and obtain formal cognitive testing before
genetic conclusions.
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
NCLEX-Level Question Stem (2–4 sentences)
A 28-year-old woman presents for a preconception visit. She
reports a family history of early-onset cardiomyopathy in her
brother (diagnosed at age 32) and two maternal aunts with
sudden cardiac death in their 40s. Her vitals are normal and
cardiac exam reveals a subtle 2/6 systolic murmur heard best at
the left lower sternal border. Which action best addresses the
immediate risk and guides safe prenatal planning?
Page 1 of 985
,A. Reassure the patient; proceed with routine prenatal labs and
standard prenatal counseling.
B. Order an echocardiogram and refer for genetic
counseling/testing for familial cardiac disorders.
C. Send for baseline electrocardiogram (ECG) only and postpone
genetic referral until pregnancy.
D. Begin low-dose beta-blocker prophylaxis and schedule
routine prenatal care.
Correct Answer: B
Rationales
Correct (B): Jarvis emphasizes that a suspicious family history of
early-onset cardiomyopathy and sudden cardiac death warrants
targeted cardiac evaluation and genetic counseling before
pregnancy; an echocardiogram can identify subclinical
structural disease while genetic testing clarifies hereditary risk
and informs reproductive decisions. This approach prioritizes
patient safety and informed prenatal planning.
A: Reassurance alone misses significant red flags (early familial
cardiomyopathy, sudden deaths) and fails to follow Jarvis’
guidance to investigate familial patterns.
C: An ECG may detect arrhythmias but is insufficient alone to
evaluate structural cardiomyopathy risk; delaying genetic
referral risks missed preconception counseling.
D: Initiating beta-blocker therapy without diagnostic
confirmation is inappropriate and may cause harm; therapy
should follow confirmed diagnosis and specialist input.
Page 2 of 985
,Teaching Point: Family patterns of early cardiac disease require
echo + genetic counseling before pregnancy.
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
NCLEX-Level Question Stem (2–4 sentences)
A 54-year-old man reports progressive memory complaints over
2 years; his father was diagnosed with Alzheimer disease at age
78. He lives alone, works full time, and has well controlled
hypertension. Cognitive screening shows mild deficits in short-
term recall. Which interpretation and next step best reflects
evidence-based assessment of genetic and environmental
contributors?
A. Attributing symptoms to normal aging; advise social
engagement and follow up in 12 months.
B. Consider early-onset familial Alzheimer’s syndrome and refer
for immediate genetic testing.
C. Evaluate modifiable environmental contributors (vascular risk
control, sleep, substance exposure) and arrange comprehensive
cognitive assessment.
Page 3 of 985
, D. Start an acetylcholinesterase inhibitor empirically and
schedule neurology referral.
Correct Answer: C
Rationales
Correct (C): Jarvis frames cognitive complaints as
multifactorial—family history increases risk but age and
vascular risk factors are important modifiable contributors.
Comprehensive cognitive testing plus optimization of vascular
health, sleep, and exposures is evidence-based before labeling a
genetic syndrome.
A: Dismissing as normal aging ignores progressive decline and
family history; Jarvis recommends targeted assessment of risks
and function.
B: Immediate genetic testing for familial Alzheimer’s is
premature; familial early-onset syndromes are rare and require
specialist evaluation and counseling.
D: Starting dementia pharmacotherapy without confirmatory
diagnosis and specialist input is premature and not aligned with
safe practice.
Teaching Point: Cognitive decline: assess modifiable
environmental risks and obtain formal cognitive testing before
genetic conclusions.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
Page 4 of 985
