HEALTH ASSESSMENT IN NURSING
8TH EDITION
• AUTHOR(S)JANET R. WEBER, JANE
HARMON KELLEY-LANDAETA
TEST BANK
Reference
Ch. 1 — The Nurse’s Role in Health Assessment — Data Sources
& Validation
Stem
A newly admitted 72-year-old man with confusion has a
daughter who reports the patient “has been more forgetful
over the last week.” During your initial interview, the patient
denies memory problems but appears disoriented to time.
Which nursing action best validates the daughter’s report while
respecting the patient’s autonomy?
Options
A. Accept the patient’s denial and document that the patient
reports no memory problems.
,B. Ask the daughter to leave and perform a brief cognitive
screen (e.g., orientation to time, place).
C. Contact the physician immediately to request an order for a
full neurocognitive evaluation.
D. Rely on the electronic health record (EHR) previous notes
rather than family report.
Correct answer
B
Rationales
Correct (B): A focused cognitive screen integrates collateral
history with current objective assessment, validating the
daughter’s concern while preserving the patient’s autonomy
and dignity. It produces immediate, nurse-collected objective
data (orientation, short-term recall) to guide priority
interventions.
Incorrect (A): Accepting the patient’s denial without objective
assessment ignores observable disorientation and may miss
acute cognitive change.
Incorrect (C): Contacting the physician before performing a
nurse-led cognitive screen is premature; nursing assessment
data should inform communication and urgency.
Incorrect (D): Solely relying on EHR notes dismisses real-time
corroborative family report and current assessment findings.
Teaching point
Perform nurse-led focused cognitive tests to validate collateral
reports and determine urgency.
,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 — Subjective vs
Objective Data
Stem
During shift assessment a 28-year-old postpartum mother
reports “I feel very tired and I can’t stop worrying about
everything.” Her vital signs and uterine exam are within normal
limits. Which nursing interpretation and next action are most
appropriate?
Options
A. Document the patient’s statement as subjective data and
provide routine postpartum teaching.
B. Classify the statement as objective data and place comfort
measures.
C. Recognize the report as subjective data indicating possible
postpartum mood changes and perform a focused mental-
health assessment.
D. Tell the patient that fatigue is normal and schedule a follow-
up at discharge.
, Correct answer
C
Rationales
Correct (C): The patient’s verbal report is subjective data that
may signal postpartum mood disorder or anxiety; a focused
mental-health assessment is appropriate to evaluate severity,
safety (suicidal ideation), and need for referral.
Incorrect (A): Merely documenting and providing routine
teaching risks missing mental-health needs; subjective
emotional distress requires assessment beyond routine
teaching.
Incorrect (B): Subjective feelings are not objective data;
classifying them as objective is conceptually incorrect and leads
to inappropriate actions.
Incorrect (D): Minimizing the patient’s report delays
assessment and may jeopardize safety if mood disorder is
present.
Teaching point
Treat patient emotional reports as subjective data prompting
focused mental-health assessment and safety screening.
Citation
Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health Assessment
in Nursing (8th ed.). Ch. 1.
3.
8TH EDITION
• AUTHOR(S)JANET R. WEBER, JANE
HARMON KELLEY-LANDAETA
TEST BANK
Reference
Ch. 1 — The Nurse’s Role in Health Assessment — Data Sources
& Validation
Stem
A newly admitted 72-year-old man with confusion has a
daughter who reports the patient “has been more forgetful
over the last week.” During your initial interview, the patient
denies memory problems but appears disoriented to time.
Which nursing action best validates the daughter’s report while
respecting the patient’s autonomy?
Options
A. Accept the patient’s denial and document that the patient
reports no memory problems.
,B. Ask the daughter to leave and perform a brief cognitive
screen (e.g., orientation to time, place).
C. Contact the physician immediately to request an order for a
full neurocognitive evaluation.
D. Rely on the electronic health record (EHR) previous notes
rather than family report.
Correct answer
B
Rationales
Correct (B): A focused cognitive screen integrates collateral
history with current objective assessment, validating the
daughter’s concern while preserving the patient’s autonomy
and dignity. It produces immediate, nurse-collected objective
data (orientation, short-term recall) to guide priority
interventions.
Incorrect (A): Accepting the patient’s denial without objective
assessment ignores observable disorientation and may miss
acute cognitive change.
Incorrect (C): Contacting the physician before performing a
nurse-led cognitive screen is premature; nursing assessment
data should inform communication and urgency.
Incorrect (D): Solely relying on EHR notes dismisses real-time
corroborative family report and current assessment findings.
Teaching point
Perform nurse-led focused cognitive tests to validate collateral
reports and determine urgency.
,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 — Subjective vs
Objective Data
Stem
During shift assessment a 28-year-old postpartum mother
reports “I feel very tired and I can’t stop worrying about
everything.” Her vital signs and uterine exam are within normal
limits. Which nursing interpretation and next action are most
appropriate?
Options
A. Document the patient’s statement as subjective data and
provide routine postpartum teaching.
B. Classify the statement as objective data and place comfort
measures.
C. Recognize the report as subjective data indicating possible
postpartum mood changes and perform a focused mental-
health assessment.
D. Tell the patient that fatigue is normal and schedule a follow-
up at discharge.
, Correct answer
C
Rationales
Correct (C): The patient’s verbal report is subjective data that
may signal postpartum mood disorder or anxiety; a focused
mental-health assessment is appropriate to evaluate severity,
safety (suicidal ideation), and need for referral.
Incorrect (A): Merely documenting and providing routine
teaching risks missing mental-health needs; subjective
emotional distress requires assessment beyond routine
teaching.
Incorrect (B): Subjective feelings are not objective data;
classifying them as objective is conceptually incorrect and leads
to inappropriate actions.
Incorrect (D): Minimizing the patient’s report delays
assessment and may jeopardize safety if mood disorder is
present.
Teaching point
Treat patient emotional reports as subjective data prompting
focused mental-health assessment and safety screening.
Citation
Weber, J. R., & Kelley-Landaeta, J. H. (2025). Health Assessment
in Nursing (8th ed.). Ch. 1.
3.
