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 68-year-old man admitted for elective hip replacement
reports increasing forgetfulness over the past 6 months and is
quiet during your interview. His daughter, at bedside, answers
most questions. You must complete the initial health
assessment. Which is the best first nursing action?
A. Proceed with the full, standardized health history using the
daughter’s answers.
B. Ask the daughter to step out and assess the patient’s
cognitive status directly.
C. Defer assessment until the provider performs cognitive
,testing.
D. Rely on the medical record and focus only on the hip-related
assessment.
Correct answer: B
Rationale — Correct (B): Directly assessing the patient’s
cognition preserves patient-centered data collection and
autonomy. Asking the daughter to step out allows evaluation of
orientation, memory, and ability to provide history — essential
for accurate baseline. This approach identifies whether the
daughter’s reports reflect the patient’s own status or caregiver
interpretation, which affects planning and consent.
Rationale — Incorrect:
A: Using proxy answers without assessing the patient risks
inaccurate data and violates patient autonomy.
C: Deferring to provider delays nursing assessment and misses
immediate safety or communication needs.
D: Ignoring cognitive concerns may overlook urgent issues
affecting safety and discharge planning.
Teaching point: Always assess the patient directly first; use
proxies only after validating capacity.
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 —
Interviewing & Communication Skills
,Stem: A 22-year-old female college student reports abdominal
pain and is embarrassed discussing sexual history. She avoids
eye contact and answers briefly. Which nursing strategy best
facilitates a complete health history?
A. Continue with the standard questions and accept brief
answers.
B. Use open-ended, nonjudgmental phrasing and assure
confidentiality.
C. Ask the daughter or partner to provide sexual-history details.
D. Postpone sexual-history questions until discharge planning.
Correct answer: B
Rationale — Correct (B): Open-ended, nonjudgmental
questions and confidentiality statements reduce
embarrassment and encourage disclosure — essential for
accurate assessment. Therapeutic communication builds trust
and yields clinically relevant information (e.g., STI risk,
pregnancy). This is within the nurse’s role to obtain sensitive
data safely.
Rationale — Incorrect:
A: Accepting brief answers risks missing important diagnostic
information.
C: Using a proxy breaches confidentiality and may give
inaccurate information.
D: Delaying may miss urgent conditions or affect immediate
treatment decisions.
Teaching point: Use respectful, confidential interviewing to
obtain sensitive info.
, 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 & Validation
Stem: While performing an admission assessment on an
unconscious trauma patient, you note a discrepancy between
the patient’s bracelet and the triage sheet. What should the
nurse do first?
A. Document the discrepancy and continue the assessment.
B. Verify the patient’s identity using two identifiers with
available sources.
C. Proceed using the name on the bracelet because it’s
immediate.
D. Notify the physician only if medications are given.
Correct answer: B
Rationale — Correct (B): Verifying identity with two identifiers
(e.g., name and DOB or medical record number) is a safety
priority and necessary before any interventions. Immediate
verification prevents wrong-patient errors and ensures accurate
documentation and treatment. This is a standard nursing
responsibility during assessment.
Rationale — Incorrect:
A: Simply documenting without verification risks clinical errors.
C: Assuming the bracelet is correct may perpetuate a wrong-
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 68-year-old man admitted for elective hip replacement
reports increasing forgetfulness over the past 6 months and is
quiet during your interview. His daughter, at bedside, answers
most questions. You must complete the initial health
assessment. Which is the best first nursing action?
A. Proceed with the full, standardized health history using the
daughter’s answers.
B. Ask the daughter to step out and assess the patient’s
cognitive status directly.
C. Defer assessment until the provider performs cognitive
,testing.
D. Rely on the medical record and focus only on the hip-related
assessment.
Correct answer: B
Rationale — Correct (B): Directly assessing the patient’s
cognition preserves patient-centered data collection and
autonomy. Asking the daughter to step out allows evaluation of
orientation, memory, and ability to provide history — essential
for accurate baseline. This approach identifies whether the
daughter’s reports reflect the patient’s own status or caregiver
interpretation, which affects planning and consent.
Rationale — Incorrect:
A: Using proxy answers without assessing the patient risks
inaccurate data and violates patient autonomy.
C: Deferring to provider delays nursing assessment and misses
immediate safety or communication needs.
D: Ignoring cognitive concerns may overlook urgent issues
affecting safety and discharge planning.
Teaching point: Always assess the patient directly first; use
proxies only after validating capacity.
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 —
Interviewing & Communication Skills
,Stem: A 22-year-old female college student reports abdominal
pain and is embarrassed discussing sexual history. She avoids
eye contact and answers briefly. Which nursing strategy best
facilitates a complete health history?
A. Continue with the standard questions and accept brief
answers.
B. Use open-ended, nonjudgmental phrasing and assure
confidentiality.
C. Ask the daughter or partner to provide sexual-history details.
D. Postpone sexual-history questions until discharge planning.
Correct answer: B
Rationale — Correct (B): Open-ended, nonjudgmental
questions and confidentiality statements reduce
embarrassment and encourage disclosure — essential for
accurate assessment. Therapeutic communication builds trust
and yields clinically relevant information (e.g., STI risk,
pregnancy). This is within the nurse’s role to obtain sensitive
data safely.
Rationale — Incorrect:
A: Accepting brief answers risks missing important diagnostic
information.
C: Using a proxy breaches confidentiality and may give
inaccurate information.
D: Delaying may miss urgent conditions or affect immediate
treatment decisions.
Teaching point: Use respectful, confidential interviewing to
obtain sensitive info.
, 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 & Validation
Stem: While performing an admission assessment on an
unconscious trauma patient, you note a discrepancy between
the patient’s bracelet and the triage sheet. What should the
nurse do first?
A. Document the discrepancy and continue the assessment.
B. Verify the patient’s identity using two identifiers with
available sources.
C. Proceed using the name on the bracelet because it’s
immediate.
D. Notify the physician only if medications are given.
Correct answer: B
Rationale — Correct (B): Verifying identity with two identifiers
(e.g., name and DOB or medical record number) is a safety
priority and necessary before any interventions. Immediate
verification prevents wrong-patient errors and ensures accurate
documentation and treatment. This is a standard nursing
responsibility during assessment.
Rationale — Incorrect:
A: Simply documenting without verification risks clinical errors.
C: Assuming the bracelet is correct may perpetuate a wrong-
