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 (NCLEX level)
A 32-year-old woman presents for a routine visit and reports
her mother was diagnosed with breast cancer at 46 and an aunt
had ovarian cancer at 52. She is otherwise healthy; vitals are
normal and breast exam shows no masses. She asks whether
she should be worried and what to do next. There is ambiguity
about family clustering versus chance occurrence.
Page 1 of 987
,Options
A. Reassure the patient — family history is not significant until
two first-degree relatives have breast cancer.
B. Create a three-generation pedigree and refer for genetic
counseling/testing for BRCA mutations.
C. Order a diagnostic mammogram today regardless of
screening guidelines.
D. Recommend ovarian ultrasound and CA-125 now as primary
screening.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes a thorough family history (three-
generation pedigree) to identify hereditary cancer syndromes
and appropriate referral for genetic counseling when breast and
ovarian cancers occur in family members at young ages. This
approach synthesizes risk (early-onset, multiple relatives) and
supports safe, evidence-based decision-making (cascade testing
and targeted surveillance).
Incorrect (A): Minimizes risk — Jarvis notes that single affected
relative thresholds are context-dependent; early-onset breast
plus ovarian cancer in relatives raises concern even with one
first-degree relative.
Incorrect (C): Immediate diagnostic mammography is not
indicated without abnormal exam or focal symptoms;
management should be guided by risk stratification after
Page 2 of 987
,pedigree and counseling.
Incorrect (D): Ovarian ultrasound and CA-125 are not
recommended as routine screening for asymptomatic women;
genetic risk assessment should precede such testing.
Teaching Point
Three-generation pedigree guides genetic risk and informs
counseling/referral.
Citation (APA)
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 (NCLEX level)
A 6-year-old boy is brought for lethargy and abdominal pain.
Mother reports pica and that the family recently moved into an
older rental built before 1978. On exam he is pale and has a
slightly decreased attention span; vitals stable. A fingerstick
hemoglobin is 9.6 g/dL. The clinical picture is ambiguous
between nutritional anemia and environmental toxicity.
Options
A. Start iron supplementation and schedule follow-up in 2
months.
Page 3 of 987
, B. Obtain a venous blood lead level and remove environmental
exposures pending results.
C. Order stool ova and parasites testing as the first diagnostic
step.
D. Reassure the mother; pica in children is age-appropriate and
self-limited.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes environmental exposure
assessment — older housing is a risk for lead exposure and pica
increases ingestion risk. A venous blood lead level is the
appropriate immediate test; removing exposure and addressing
safety are urgent as lead can cause neurodevelopmental harm.
Incorrect (A): While iron deficiency is a consideration, starting
iron without evaluating for lead could mask or delay diagnosis
of lead poisoning; Jarvis supports targeted testing when
environmental risk exists.
Incorrect (C): Parasites may cause anemia but are less likely
given the specific lead exposure risks; priority is confirming lead
level.
Incorrect (D): Dismisses a red flag; Jarvis highlights that pica
with exposure to old paint warrants prompt evaluation, not
reassurance.
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 (NCLEX level)
A 32-year-old woman presents for a routine visit and reports
her mother was diagnosed with breast cancer at 46 and an aunt
had ovarian cancer at 52. She is otherwise healthy; vitals are
normal and breast exam shows no masses. She asks whether
she should be worried and what to do next. There is ambiguity
about family clustering versus chance occurrence.
Page 1 of 987
,Options
A. Reassure the patient — family history is not significant until
two first-degree relatives have breast cancer.
B. Create a three-generation pedigree and refer for genetic
counseling/testing for BRCA mutations.
C. Order a diagnostic mammogram today regardless of
screening guidelines.
D. Recommend ovarian ultrasound and CA-125 now as primary
screening.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes a thorough family history (three-
generation pedigree) to identify hereditary cancer syndromes
and appropriate referral for genetic counseling when breast and
ovarian cancers occur in family members at young ages. This
approach synthesizes risk (early-onset, multiple relatives) and
supports safe, evidence-based decision-making (cascade testing
and targeted surveillance).
Incorrect (A): Minimizes risk — Jarvis notes that single affected
relative thresholds are context-dependent; early-onset breast
plus ovarian cancer in relatives raises concern even with one
first-degree relative.
Incorrect (C): Immediate diagnostic mammography is not
indicated without abnormal exam or focal symptoms;
management should be guided by risk stratification after
Page 2 of 987
,pedigree and counseling.
Incorrect (D): Ovarian ultrasound and CA-125 are not
recommended as routine screening for asymptomatic women;
genetic risk assessment should precede such testing.
Teaching Point
Three-generation pedigree guides genetic risk and informs
counseling/referral.
Citation (APA)
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 (NCLEX level)
A 6-year-old boy is brought for lethargy and abdominal pain.
Mother reports pica and that the family recently moved into an
older rental built before 1978. On exam he is pale and has a
slightly decreased attention span; vitals stable. A fingerstick
hemoglobin is 9.6 g/dL. The clinical picture is ambiguous
between nutritional anemia and environmental toxicity.
Options
A. Start iron supplementation and schedule follow-up in 2
months.
Page 3 of 987
, B. Obtain a venous blood lead level and remove environmental
exposures pending results.
C. Order stool ova and parasites testing as the first diagnostic
step.
D. Reassure the mother; pica in children is age-appropriate and
self-limited.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes environmental exposure
assessment — older housing is a risk for lead exposure and pica
increases ingestion risk. A venous blood lead level is the
appropriate immediate test; removing exposure and addressing
safety are urgent as lead can cause neurodevelopmental harm.
Incorrect (A): While iron deficiency is a consideration, starting
iron without evaluating for lead could mask or delay diagnosis
of lead poisoning; Jarvis supports targeted testing when
environmental risk exists.
Incorrect (C): Parasites may cause anemia but are less likely
given the specific lead exposure risks; priority is confirming lead
level.
Incorrect (D): Dismisses a red flag; Jarvis highlights that pica
with exposure to old paint warrants prompt evaluation, not
reassurance.
Page 4 of 987
