TEST BANK
Health Assessment in Nursing
Janet R. Weber, and Jane H. Kelley
7th Edition
,Table of Contents
Chapter 01 The Nurse’s Role in Health Assessment 1
Chapter 02 Collecting Subjective Data The Interview and Health History 16
Chapter 03 Collecting Objective Data The Physical Examination 34
Chapter 04 Validating and Documenting Data 47
Chapter 05 Thinking Critically to Analyze Data to Make Informed Clinical Judgments 65
Chapter 06 Assessing Mental Status Including Risk for Substance Abuse 85
Chapter 07 Assessing Psychosocial, Cognitive, and Moral Development 101
Chapter 08 Assessing General Health Status and Vital Signs 115
Chapter 09 Assessing Pain 133
Chapter 10 Assessing for Violence 149
Chapter 11 Assessing Culture 166
Chapter 12 Assessing Spirituality and Religious Practices 175
Chapter 13 Assessing Nutritional Status 187
Chapter 14 Assessing Skin, Hair, and Nails 202
Chapter 15 Assessing Head and Neck 222
Chapter 16 Assessing Eyes 239
Chapter 17 Assessing Ears 256
Chapter 18 Assessing Mouth, Throat, Nose, and Sinuses 273
Chapter 19 Assessing Thorax and Lungs 289
Chapter 20 Assessing Breasts and Lymphatic System 306
Chapter 21 Assessing Heart and Neck Vessels 320
Chapter 22 Assessing Peripheral Vascular System 338
Chapter 23 Assessing Abdomen 354
Chapter 24 Assessing Musculoskeletal System 371
Chapter 25 Assessing Neurologic System 387
Chapter 26 Assessing Male Genitalia and Rectum 404
Chapter 27 Assessing Female Genitalia, Anus, and Rectum 424
Chapter 28 Pulling It All Together Integrated Head-To-Toe Assessment 441
Chapter 29 Assessing Childbearing Women 457
Chapter 30 Assessing Newborns and Infants 473
Chapter 31 Assessing Children and Adolescents 488
Chapter 32 Assessing Older Adults 504
Chapter 33 Assessing Families 518
Chapter 34 Assessing Communities 528
, Chapter 1, The Nurse’s Role in Health Assessment
1. Which individual typically would be responsible for collecting the subjective data on a
client during the initial comprehensive assessment?
a. Physician
b. Nurse
c. Secretary
d. Technician
ANS: B
Feedback: The nurse typically collects the subjective data, especially those related to the
client's overall function. However, depending on the setting, other members of the health
care team may participate in various parts of the objective data collection.
PTS: 1 REF: Page and Header: p. 3, Types of Health Assessment
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
2. When performing the steps of the assessment phase of the nursing process, which of the
following would the nurse do first?
a. Collect objective data
b. Validate the data
c. Collect subjective data
d. Document the data
ANS: C
Feedback: With assessment, subjective then objective data is collected. This is followed by
validation and then documentation of data.
PTS: 1 REF: Page and Header: p. 4, Steps of Health Assessment
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 1
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An instructor is describing a comprehensive nursing health assessment to a group of
students. The instructor determines that the teaching was successful when the students
identify which of the following as the overall purpose?
a. Collect large quantities of data
b. Assist the physician
c. Validate previous data
d. Make a clinical judgment
ANS: D
Feedback: The purpose of a nursing health assessment is to collect subjective and objective
data to determine a client's overall level of functioning to make a professional clinical
judgment.
PTS: 1 REF: Page and Header: p. 2, Focus of Health Assessment in Nursing
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 1
______________________________________________________________________________________________
1|Page
, KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. A nurse on a postsurgical unit is admitting a client following the client's cholecystectomy.
What is the overall purpose of assessment for this client?
a. Collecting accurate data
b. Assisting the primary care provider
c. Validating previous data
d. Making clinical judgments
ANS: D
Feedback: The purpose of a nursing health assessment is to collect subjective and objective
data to determine a client's overall level of functioning to make a professional clinical
judgment. Collecting and validating data are means to this end. The primary purpose of
assessment is not to assist the primary care provider.
PTS: 1 REF: Page and Header: p. 2, Focus of Health Assessment in Nursing
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
5. A client has presented to the emergency department (ED) with complaints of abdominal
pain. Which member of the care team would most likely be responsible for collecting the
subjective data on the client during the initial comprehensive assessment?
a. Gastroenterologist
b. ED nurse
c. Admissions clerk
d. Diagnostic technician
ANS: B
Feedback: The nurse typically collects the subjective data, especially those related to the
client's overall function. However, depending on the setting, other members of the health
care team may participate in various parts of the objective data collection. Referral to a
medical specialist would not take place at this early stage of assessment.
PTS: 1 REF: Page and Header: p. 3, Types of Health Assessment
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
6. The nurse has completed an initial assessment of a newly admitted client and is applying the
nursing process to plan the client's care. What principle should the nurse apply when using
the nursing process?
a. Each step is independent of the others.
b. It is ongoing and continuous.
c. It is used primarily in acute care settings.
d. It involves independent nursing actions.
ANS: B
______________________________________________________________________________________________
2|Page
Health Assessment in Nursing
Janet R. Weber, and Jane H. Kelley
7th Edition
,Table of Contents
Chapter 01 The Nurse’s Role in Health Assessment 1
Chapter 02 Collecting Subjective Data The Interview and Health History 16
Chapter 03 Collecting Objective Data The Physical Examination 34
Chapter 04 Validating and Documenting Data 47
Chapter 05 Thinking Critically to Analyze Data to Make Informed Clinical Judgments 65
Chapter 06 Assessing Mental Status Including Risk for Substance Abuse 85
Chapter 07 Assessing Psychosocial, Cognitive, and Moral Development 101
Chapter 08 Assessing General Health Status and Vital Signs 115
Chapter 09 Assessing Pain 133
Chapter 10 Assessing for Violence 149
Chapter 11 Assessing Culture 166
Chapter 12 Assessing Spirituality and Religious Practices 175
Chapter 13 Assessing Nutritional Status 187
Chapter 14 Assessing Skin, Hair, and Nails 202
Chapter 15 Assessing Head and Neck 222
Chapter 16 Assessing Eyes 239
Chapter 17 Assessing Ears 256
Chapter 18 Assessing Mouth, Throat, Nose, and Sinuses 273
Chapter 19 Assessing Thorax and Lungs 289
Chapter 20 Assessing Breasts and Lymphatic System 306
Chapter 21 Assessing Heart and Neck Vessels 320
Chapter 22 Assessing Peripheral Vascular System 338
Chapter 23 Assessing Abdomen 354
Chapter 24 Assessing Musculoskeletal System 371
Chapter 25 Assessing Neurologic System 387
Chapter 26 Assessing Male Genitalia and Rectum 404
Chapter 27 Assessing Female Genitalia, Anus, and Rectum 424
Chapter 28 Pulling It All Together Integrated Head-To-Toe Assessment 441
Chapter 29 Assessing Childbearing Women 457
Chapter 30 Assessing Newborns and Infants 473
Chapter 31 Assessing Children and Adolescents 488
Chapter 32 Assessing Older Adults 504
Chapter 33 Assessing Families 518
Chapter 34 Assessing Communities 528
, Chapter 1, The Nurse’s Role in Health Assessment
1. Which individual typically would be responsible for collecting the subjective data on a
client during the initial comprehensive assessment?
a. Physician
b. Nurse
c. Secretary
d. Technician
ANS: B
Feedback: The nurse typically collects the subjective data, especially those related to the
client's overall function. However, depending on the setting, other members of the health
care team may participate in various parts of the objective data collection.
PTS: 1 REF: Page and Header: p. 3, Types of Health Assessment
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
2. When performing the steps of the assessment phase of the nursing process, which of the
following would the nurse do first?
a. Collect objective data
b. Validate the data
c. Collect subjective data
d. Document the data
ANS: C
Feedback: With assessment, subjective then objective data is collected. This is followed by
validation and then documentation of data.
PTS: 1 REF: Page and Header: p. 4, Steps of Health Assessment
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 1
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An instructor is describing a comprehensive nursing health assessment to a group of
students. The instructor determines that the teaching was successful when the students
identify which of the following as the overall purpose?
a. Collect large quantities of data
b. Assist the physician
c. Validate previous data
d. Make a clinical judgment
ANS: D
Feedback: The purpose of a nursing health assessment is to collect subjective and objective
data to determine a client's overall level of functioning to make a professional clinical
judgment.
PTS: 1 REF: Page and Header: p. 2, Focus of Health Assessment in Nursing
NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 1
______________________________________________________________________________________________
1|Page
, KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. A nurse on a postsurgical unit is admitting a client following the client's cholecystectomy.
What is the overall purpose of assessment for this client?
a. Collecting accurate data
b. Assisting the primary care provider
c. Validating previous data
d. Making clinical judgments
ANS: D
Feedback: The purpose of a nursing health assessment is to collect subjective and objective
data to determine a client's overall level of functioning to make a professional clinical
judgment. Collecting and validating data are means to this end. The primary purpose of
assessment is not to assist the primary care provider.
PTS: 1 REF: Page and Header: p. 2, Focus of Health Assessment in Nursing
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
5. A client has presented to the emergency department (ED) with complaints of abdominal
pain. Which member of the care team would most likely be responsible for collecting the
subjective data on the client during the initial comprehensive assessment?
a. Gastroenterologist
b. ED nurse
c. Admissions clerk
d. Diagnostic technician
ANS: B
Feedback: The nurse typically collects the subjective data, especially those related to the
client's overall function. However, depending on the setting, other members of the health
care team may participate in various parts of the objective data collection. Referral to a
medical specialist would not take place at this early stage of assessment.
PTS: 1 REF: Page and Header: p. 3, Types of Health Assessment
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
6. The nurse has completed an initial assessment of a newly admitted client and is applying the
nursing process to plan the client's care. What principle should the nurse apply when using
the nursing process?
a. Each step is independent of the others.
b. It is ongoing and continuous.
c. It is used primarily in acute care settings.
d. It involves independent nursing actions.
ANS: B
______________________________________________________________________________________________
2|Page
