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 34-year-old woman reports her mother was diagnosed with
early-onset breast cancer at 43 and her maternal aunt had
ovarian cancer. She is anxious and asks what to do. On exam she
appears well, BMI 23, no palpable breast masses. How should
the nurse prioritize next steps for her care?
Page 1 of 987
,A. Reassure and recommend routine mammography at age 40
per standard screening.
B. Refer for genetic counseling and risk assessment for
hereditary breast–ovarian cancer.
C. Order a diagnostic bilateral mammogram and breast
ultrasound immediately.
D. Suggest lifestyle modification and annual clinical breast
exams only.
Correct Answer
B
Rationale — Correct
Jarvis emphasizes targeted assessment of family history across
three generations when patterns suggest hereditary risk. Early-
onset (mother at 43) plus ovarian cancer in a first-degree
relative increases pretest probability of a hereditary syndrome;
genetic counseling is the evidence-based next step to
determine testing and tailored surveillance. This choice aligns
with safety-focused practice by identifying high-risk individuals
who may need earlier or intensified screening.
Rationale — Incorrect
A. Routine screening may miss early risk—does not address
possible hereditary syndrome.
C. Immediate imaging is not first-line absent a palpable mass or
focal symptom and may lead to unnecessary tests without prior
risk stratification.
Page 2 of 987
,D. Lifestyle advice and annual exams alone under-recognize
genetic risk and delay appropriate risk-based intervention.
Teaching Point
Three-generation pedigree and genetic counseling for early-
onset or multiple related cancers.
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 28-year-old man presents for a preconception visit. He
reports he and his partner are of Ashkenazi Jewish ancestry and
concerned about inherited conditions. He has no symptoms;
physical exam normal. Which is the most appropriate evidence-
based action now?
A. Recommend carrier screening tailored to ancestry and offer
genetic counseling.
B. Defer genetic testing until pregnancy is confirmed.
C. Order whole-genome sequencing immediately.
D. Inform them that ancestry is not important and proceed with
routine prenatal care.
Page 3 of 987
, Correct Answer
A
Rationale — Correct
Jarvis highlights the importance of ancestry-informed risk
assessment and preconception carrier screening when certain
populations have higher carrier frequencies. Offering ancestry-
tailored carrier screening with counseling is evidence-based,
allows informed reproductive choices, and prevents avoidable
adverse outcomes. This prioritizes prevention and shared
decision-making.
Rationale — Incorrect
B. Waiting until pregnancy misses optimal preconception
planning opportunities.
C. Whole-genome sequencing is not indicated as first-line
carrier screening; it's costly and not targeted.
D. Ancestry can significantly alter pretest probability—ignoring
it is poor assessment practice.
Teaching Point
Offer ancestry-based carrier screening preconception with
genetic counseling.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
3
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 34-year-old woman reports her mother was diagnosed with
early-onset breast cancer at 43 and her maternal aunt had
ovarian cancer. She is anxious and asks what to do. On exam she
appears well, BMI 23, no palpable breast masses. How should
the nurse prioritize next steps for her care?
Page 1 of 987
,A. Reassure and recommend routine mammography at age 40
per standard screening.
B. Refer for genetic counseling and risk assessment for
hereditary breast–ovarian cancer.
C. Order a diagnostic bilateral mammogram and breast
ultrasound immediately.
D. Suggest lifestyle modification and annual clinical breast
exams only.
Correct Answer
B
Rationale — Correct
Jarvis emphasizes targeted assessment of family history across
three generations when patterns suggest hereditary risk. Early-
onset (mother at 43) plus ovarian cancer in a first-degree
relative increases pretest probability of a hereditary syndrome;
genetic counseling is the evidence-based next step to
determine testing and tailored surveillance. This choice aligns
with safety-focused practice by identifying high-risk individuals
who may need earlier or intensified screening.
Rationale — Incorrect
A. Routine screening may miss early risk—does not address
possible hereditary syndrome.
C. Immediate imaging is not first-line absent a palpable mass or
focal symptom and may lead to unnecessary tests without prior
risk stratification.
Page 2 of 987
,D. Lifestyle advice and annual exams alone under-recognize
genetic risk and delay appropriate risk-based intervention.
Teaching Point
Three-generation pedigree and genetic counseling for early-
onset or multiple related cancers.
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 28-year-old man presents for a preconception visit. He
reports he and his partner are of Ashkenazi Jewish ancestry and
concerned about inherited conditions. He has no symptoms;
physical exam normal. Which is the most appropriate evidence-
based action now?
A. Recommend carrier screening tailored to ancestry and offer
genetic counseling.
B. Defer genetic testing until pregnancy is confirmed.
C. Order whole-genome sequencing immediately.
D. Inform them that ancestry is not important and proceed with
routine prenatal care.
Page 3 of 987
, Correct Answer
A
Rationale — Correct
Jarvis highlights the importance of ancestry-informed risk
assessment and preconception carrier screening when certain
populations have higher carrier frequencies. Offering ancestry-
tailored carrier screening with counseling is evidence-based,
allows informed reproductive choices, and prevents avoidable
adverse outcomes. This prioritizes prevention and shared
decision-making.
Rationale — Incorrect
B. Waiting until pregnancy misses optimal preconception
planning opportunities.
C. Whole-genome sequencing is not indicated as first-line
carrier screening; it's costly and not targeted.
D. Ancestry can significantly alter pretest probability—ignoring
it is poor assessment practice.
Teaching Point
Offer ancestry-based carrier screening preconception with
genetic counseling.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
3
Page 4 of 987
