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 woman presents for a preconception visit. She
reports that her mother had “early-onset” Alzheimer disease
(diagnosed at 57) and that a maternal aunt had a child with a
neural tube defect. Her own physical exam and routine lab tests
are unremarkable. Which assessment action best integrates
Jarvis’ evidence-based approach for genetic and environmental
risk?
Page 1 of 984
,A. Reassure the patient: family history is not strongly predictive
without genetic testing.
B. Construct a three-generation pedigree and review modifiable
environmental exposures (e.g., folate, teratogens).
C. Order immediate genetic sequencing for all known Alzheimer
genes and neural tube defect polymorphisms.
D. Recommend adoption of a “wait-and-see” approach;
reassess family history only if symptoms appear.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes creating a detailed family history
(three-generation pedigree) to reveal inheritance patterns and
combining that with environmental/behavioral exposure
assessment. This approach supports diagnostic reasoning and
identification of modifiable risks (e.g., folate deficiency,
teratogen exposure) before reflexive testing. It is evidence-
based and patient-centered.
A: Too dismissive — family history offers actionable risk
stratification; Jarvis instructs clinicians to gather and interpret
pedigree data rather than simply reassure.
C: Premature—genetic sequencing may be appropriate after
pedigree/ counseling indicates high risk; immediate blanket
sequencing is not evidence-based and may cause unnecessary
anxiety.
D: Unsafe — delaying assessment ignores preventive
Page 2 of 984
,opportunities (e.g., folate supplementation) and violates Jarvis’
proactive assessment principles.
Teaching point
Build a three-generation pedigree and screen exposures to
identify modifiable reproductive risks.
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 42-year-old man reports he smokes 1 pack/day, works in a
battery-recycling plant, and his father died of coronary artery
disease at age 52. On exam his blood pressure is 138/86 mm Hg
and BMI 29. Which interpretation best describes his combined
genetic and environmental risk?
A. Genetic predisposition explains his cardiovascular risk;
environmental factors are minor.
B. Environmental exposures (smoking, lead/polish exposure)
and family history interact to increase his overall risk — both
require assessment and intervention.
C. Only modifiable risks (smoking, BMI) matter now; family
Page 3 of 984
, history is irrelevant because he is asymptomatic.
D. Because his blood pressure is below 140 systolic, no
immediate action is needed.
Correct answer
B
Rationales
Correct (B): Jarvis’ framework integrates genetics with
environment: gene-environment interactions elevate disease
risk beyond either factor alone. A thorough assessment and
targeted interventions (smoking cessation, occupational
exposure evaluation, risk factor modification) are warranted.
A: Incorrect — it minimizes significant environmental
influences; Jarvis stresses dynamic interaction between genes
and environment.
C: Incorrect — family history provides risk stratification and
influences screening/timing of interventions despite current
symptom absence.
D: Risk-based management requires more than a single BP
threshold; given family history and other risks, intervention and
monitoring are appropriate.
Teaching point
Assess both family history and exposures—gene-environment
interactions change screening and prevention priorities.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1. Elsevier Shop
Page 4 of 984
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 woman presents for a preconception visit. She
reports that her mother had “early-onset” Alzheimer disease
(diagnosed at 57) and that a maternal aunt had a child with a
neural tube defect. Her own physical exam and routine lab tests
are unremarkable. Which assessment action best integrates
Jarvis’ evidence-based approach for genetic and environmental
risk?
Page 1 of 984
,A. Reassure the patient: family history is not strongly predictive
without genetic testing.
B. Construct a three-generation pedigree and review modifiable
environmental exposures (e.g., folate, teratogens).
C. Order immediate genetic sequencing for all known Alzheimer
genes and neural tube defect polymorphisms.
D. Recommend adoption of a “wait-and-see” approach;
reassess family history only if symptoms appear.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes creating a detailed family history
(three-generation pedigree) to reveal inheritance patterns and
combining that with environmental/behavioral exposure
assessment. This approach supports diagnostic reasoning and
identification of modifiable risks (e.g., folate deficiency,
teratogen exposure) before reflexive testing. It is evidence-
based and patient-centered.
A: Too dismissive — family history offers actionable risk
stratification; Jarvis instructs clinicians to gather and interpret
pedigree data rather than simply reassure.
C: Premature—genetic sequencing may be appropriate after
pedigree/ counseling indicates high risk; immediate blanket
sequencing is not evidence-based and may cause unnecessary
anxiety.
D: Unsafe — delaying assessment ignores preventive
Page 2 of 984
,opportunities (e.g., folate supplementation) and violates Jarvis’
proactive assessment principles.
Teaching point
Build a three-generation pedigree and screen exposures to
identify modifiable reproductive risks.
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 42-year-old man reports he smokes 1 pack/day, works in a
battery-recycling plant, and his father died of coronary artery
disease at age 52. On exam his blood pressure is 138/86 mm Hg
and BMI 29. Which interpretation best describes his combined
genetic and environmental risk?
A. Genetic predisposition explains his cardiovascular risk;
environmental factors are minor.
B. Environmental exposures (smoking, lead/polish exposure)
and family history interact to increase his overall risk — both
require assessment and intervention.
C. Only modifiable risks (smoking, BMI) matter now; family
Page 3 of 984
, history is irrelevant because he is asymptomatic.
D. Because his blood pressure is below 140 systolic, no
immediate action is needed.
Correct answer
B
Rationales
Correct (B): Jarvis’ framework integrates genetics with
environment: gene-environment interactions elevate disease
risk beyond either factor alone. A thorough assessment and
targeted interventions (smoking cessation, occupational
exposure evaluation, risk factor modification) are warranted.
A: Incorrect — it minimizes significant environmental
influences; Jarvis stresses dynamic interaction between genes
and environment.
C: Incorrect — family history provides risk stratification and
influences screening/timing of interventions despite current
symptom absence.
D: Risk-based management requires more than a single BP
threshold; given family history and other risks, intervention and
monitoring are appropriate.
Teaching point
Assess both family history and exposures—gene-environment
interactions change screening and prevention priorities.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1. Elsevier Shop
Page 4 of 984
