HEALTH ASSESSMENT IN NURSING
8TH EDITION
• AUTHOR(S)JANET R. WEBER, JANE
HARMON KELLEY-LANDAETA
TEST BANK
1)
Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Purpose & Scope of Assessment
Stem: A 56-year-old man arrives for a routine visit. He reports
“no complaints” but the nurse notes a 6-kg weight loss in 2
months on intake vitals and observes a slightly labored gait.
Which nursing action best reflects the nurse’s role in the initial
health assessment?
A. Document the patient’s self-report as the primary finding
and schedule follow-up in 6 months.
B. Include objective observations (weight loss, gait) and begin
focused questioning for contributing factors.
C. Assume weight loss is intentional and advise an exercise
,program.
D. Refer immediately to physical therapy without further
assessment.
Correct answer: B
Rationale — Correct (B): The nurse’s role includes collecting
both subjective and objective data, recognizing abnormal
findings (unintentional weight loss, altered gait), and initiating
focused questioning to determine cause. This integrates history,
observation, and prioritization for further assessment.
Beginning targeted assessment guides appropriate next steps.
Rationale — Incorrect:
A. Incorrect — Relying only on self-report misses abnormal
objective findings and delays timely evaluation.
C. Incorrect — Assuming intentionality is premature and may
miss pathology; exercise advice is not first-line.
D. Incorrect — Immediate referral without further nursing
assessment and history is premature and bypasses nursing
judgment.
Teaching point: Combine subjective report with objective
findings and pursue targeted questions immediately.
Citation: Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health
Assessment in Nursing (8th ed.). Ch. 1.
2)
,Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Types of Data (Subjective vs Objective)
Stem: A nurse caring for a 24-year-old postpartum client
documents “patient reports breast tenderness” and notes
“erythema and a small cracked nipple” on inspection. Which
statement best illustrates correct differentiation of data types
and next nursing priority?
A. Both entries are subjective; encourage the patient to
massage breasts.
B. Breast tenderness is objective and erythema is subjective;
recommend warm compresses.
C. Tenderness is subjective; erythema and cracked nipple are
objective — assess for mastitis and develop plan.
D. Both are objective; discharge the patient with no
interventions.
Correct answer: C
Rationale — Correct (C): Nursing assessment differentiates
subjective data (patient-reported tenderness) from objective
findings (erythema, cracked nipple). Combining these suggests
risk for mastitis or infection; nurse should assess further (e.g.,
fever, drainage) and plan interventions or referral.
Rationale — Incorrect:
A. Incorrect — Erythema and cracked nipple are observable
objective findings; massage may be harmful without
assessment.
, B. Incorrect — Tenderness is subjective; labeling it objective is
wrong.
D. Incorrect — Ignoring objective signs is unsafe and
inconsistent with nursing scope.
Teaching point: Distinguish subjective complaints from
objective signs; act on abnormal objective findings promptly.
Citation: Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health
Assessment in Nursing (8th ed.). Ch. 1.
3)
Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Sources of Data & Family Involvement
Stem: While assessing an 8-year-old with asthma, the child’s
mother provides most of the history. The child appears anxious
and gives brief answers. Which nursing approach best ensures
complete, developmentally appropriate assessment?
A. Accept the mother’s history as complete and skip
interviewing the child.
B. Interview the mother privately and then engage the child
with age-appropriate questions and observation.
C. Ask only the child about symptoms to encourage
independence.
D. Rely solely on prior medical records since the mother is
present.
8TH EDITION
• AUTHOR(S)JANET R. WEBER, JANE
HARMON KELLEY-LANDAETA
TEST BANK
1)
Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Purpose & Scope of Assessment
Stem: A 56-year-old man arrives for a routine visit. He reports
“no complaints” but the nurse notes a 6-kg weight loss in 2
months on intake vitals and observes a slightly labored gait.
Which nursing action best reflects the nurse’s role in the initial
health assessment?
A. Document the patient’s self-report as the primary finding
and schedule follow-up in 6 months.
B. Include objective observations (weight loss, gait) and begin
focused questioning for contributing factors.
C. Assume weight loss is intentional and advise an exercise
,program.
D. Refer immediately to physical therapy without further
assessment.
Correct answer: B
Rationale — Correct (B): The nurse’s role includes collecting
both subjective and objective data, recognizing abnormal
findings (unintentional weight loss, altered gait), and initiating
focused questioning to determine cause. This integrates history,
observation, and prioritization for further assessment.
Beginning targeted assessment guides appropriate next steps.
Rationale — Incorrect:
A. Incorrect — Relying only on self-report misses abnormal
objective findings and delays timely evaluation.
C. Incorrect — Assuming intentionality is premature and may
miss pathology; exercise advice is not first-line.
D. Incorrect — Immediate referral without further nursing
assessment and history is premature and bypasses nursing
judgment.
Teaching point: Combine subjective report with objective
findings and pursue targeted questions immediately.
Citation: Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health
Assessment in Nursing (8th ed.). Ch. 1.
2)
,Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Types of Data (Subjective vs Objective)
Stem: A nurse caring for a 24-year-old postpartum client
documents “patient reports breast tenderness” and notes
“erythema and a small cracked nipple” on inspection. Which
statement best illustrates correct differentiation of data types
and next nursing priority?
A. Both entries are subjective; encourage the patient to
massage breasts.
B. Breast tenderness is objective and erythema is subjective;
recommend warm compresses.
C. Tenderness is subjective; erythema and cracked nipple are
objective — assess for mastitis and develop plan.
D. Both are objective; discharge the patient with no
interventions.
Correct answer: C
Rationale — Correct (C): Nursing assessment differentiates
subjective data (patient-reported tenderness) from objective
findings (erythema, cracked nipple). Combining these suggests
risk for mastitis or infection; nurse should assess further (e.g.,
fever, drainage) and plan interventions or referral.
Rationale — Incorrect:
A. Incorrect — Erythema and cracked nipple are observable
objective findings; massage may be harmful without
assessment.
, B. Incorrect — Tenderness is subjective; labeling it objective is
wrong.
D. Incorrect — Ignoring objective signs is unsafe and
inconsistent with nursing scope.
Teaching point: Distinguish subjective complaints from
objective signs; act on abnormal objective findings promptly.
Citation: Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health
Assessment in Nursing (8th ed.). Ch. 1.
3)
Reference: Ch. 1 — The Nurse’s Role in Health Assessment —
Sources of Data & Family Involvement
Stem: While assessing an 8-year-old with asthma, the child’s
mother provides most of the history. The child appears anxious
and gives brief answers. Which nursing approach best ensures
complete, developmentally appropriate assessment?
A. Accept the mother’s history as complete and skip
interviewing the child.
B. Interview the mother privately and then engage the child
with age-appropriate questions and observation.
C. Ask only the child about symptoms to encourage
independence.
D. Rely solely on prior medical records since the mother is
present.
