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Emergency Care, 13e (Limmer et al.)
Chapter 13 Vital Signs and Monitoring Devices
1) When the heart contracts and forces blood into the arteries, the pressure created is known as
the:
A) pulse pressure.
B) systolic blood pressure.
C) diastolic blood pressure.
D) central venous pressure.
Answer: B
Explanation: A) INCORRECT. Although when the heart contracts it does generate a pulse, the
arterial pressure is not called pulse pressure.
B) CORRECT. The pressure in the arteries when the heart contracts is called systolic blood
pressure.
C) INCORRECT. Diastolic blood pressure is the pressure remaining in the arteries when the
heart relaxes.
D) INCORRECT. Arterial pressure would not be referred to as venous.
Page Ref: 316
Objective: 13.1
2) What is the pressure remaining in the arteries after the pulse wave has passed through?
A) Venous pressure
B) Systolic blood pressure
C) Diastolic blood pressure
D) Resting blood pressure
Answer: C
Explanation: A) INCORRECT. The term venous would not be used in reference to arterial
pressure.
B) INCORRECT. The pressure in the arteries when the heart contracts is called systolic blood
pressure.
C) CORRECT. Diastolic blood pressure is the pressure remaining in the arteries when the heart
relaxes.
D) INCORRECT. A resting blood pressure refers to the condition of the patient, not a particular
pressure during the circulatory cycle.
Page Ref: 316
Objective: 13.1
1
Copyright © 2016 Pearson Education, Inc.
3) A patient with a pulse rate of 120 beats per minute is considered which of the following?
A) Dyscardic
B) Normocardic
C) Tachycardic
D) Bradycardic
Answer: C
Explanation: A) INCORRECT. Dyscardic is not a commonly used medical term and it does not
apply to a pulse rate of 120.
B) INCORRECT. The term normocardic is sometimes used in reference to a normal heart
rhythm or pulse rate; it does not apply in this scenario.
C) CORRECT. A pulse rate above 100 beats per minute is considered rapid, or tachycardic.
D) INCORRECT. The term bradycardia generally refers to a heart rate below 60 beats per
minute.
Page Ref: 309
Objective: 13.1
4) The method of taking blood pressure by using a stethoscope to listen to the characteristic
sounds produced is called:
A) auscultation.
B) articulation.
C) palpation.
D) pulsation.
Answer: A
Explanation: A) CORRECT. The term auscultation means listening.
B) INCORRECT. Articulation does not refer to blood pressure or listening.
C) INCORRECT. The term palpation refers to feeling or touching.
D) INCORRECT. Pulsation is a rhythmic throbbing, unrelated to listening for sounds.
Page Ref: 318
Objective: 13.1
5) Upon assessment of your patient, you notice that he has cool, sweaty skin. This finding is best
described as which of the following?
A) Diagnosis
B) Sign
C) Complaint
D) Symptom
Answer: B
Explanation: A) INCORRECT. A diagnosis is a determination of a specific medical condition.
A patient's appearance is not a diagnosis.
B) CORRECT. A sign is something that can be observed, palpated, or measured.
C) INCORRECT. A complaint is generally a reason that the patient has sought care, not an
observation during the assessment.
D) INCORRECT. A symptom is how the patient feels, not generally something that is
observable by the EMT.
Page Ref: 309
Objective: 13.2
2
6) The abbreviation mmHg indicates that the blood pressure is measured by which of the
following comparisons?
A) Minimum heart rate
B) Millimeters of mercury
C) Millimeters of water
D) Atmospheric pressure
Answer: B
Explanation: A) INCORRECT. Minimum heart rate is not abbreviated as mmHg.
B) CORRECT. Millimeters of mercury, or mmHg, refers to the units on the blood pressure
gauge.
C) INCORRECT. The abbreviation mmHg does not indicate a water measurement.
D) INCORRECT. Atmospheric pressure is not referred to by the abbreviation mmHg.
Page Ref: 318
Objective: 13.2
7) The first set of vital sign measurements obtained are often referred to as which of the
following?
A) Baseline vital signs
B) Normal vital signs
C) Standard vital signs
D) None of the above
Answer: A
Explanation: A) CORRECT. The first measurements you obtain are called the baseline vital
signs. You can gain even more valuable information when you repeat the vital signs and compare
them to the baseline measurements.
B) INCORRECT. The first set of vital signs obtained is not generally called normal.
C) INCORRECT. The term standard vital signs is not commonly used to describe the first set of
vital signs obtained by an EMT.
D) INCORRECT. One of the options provided is correct.
Page Ref: 309
Objective: 13.2
8) An oxygen saturation of 97% is considered which of the following?

A) Severe hypoxia
B) Normal
C) Hypoxia
D) Significant hypoxia
Answer: B
Explanation: A) INCORRECT. An SpO2 of 85% or less indicates severe hypoxia.
B) CORRECT. The oxygen saturation, or SpO2, is typically 96 to 100% in a normal healthy
person.
C) INCORRECT. Hypoxia is generally considered any oxygen saturation reading 95% or less.
D) INCORRECT. 86 to 90% indicates significant or moderate hypoxia.
Page Ref: 324
Objective: 13.2
3
9) In a blood pressure reading of 120/80, the 120 is measuring what body process?
A) Diastolic blood pressure; when the left ventricles contract and the blood is forced into the
arteries
B) Systolic blood pressure; when the right ventricles contract and the blood is forced into the
veins
C) Systolic blood pressure; when the left ventricles contract and the blood is forced into the
arteries
D) Systolic blood pressure; when the left ventricles contract and the blood is forced into the
veins
Answer: C
Explanation: A) INCORRECT. Diastolic pressure is not created when the heart contracts.
B) INCORRECT. The right ventricle does not force blood into the veins.
C) CORRECT. The first number in a blood pressure reading is the systolic pressure, which is
created when the left ventricle contracts and forces blood into the arteries.
D) INCORRECT. The left ventricle contracting should not force blood into the veins.
Page Ref: 316
Objective: 13.2
10) Which of the following are the vital signs that need to be recorded?
A) Pulse, respiration, skin color, skin temperature and condition
B) Pulse, respiration, skin color, skin temperature and condition, pupils, blood pressure, and
bowel sounds
C) Pulse, respiration, skin color, skin temperature and condition, pupils, and blood pressure
D) Pulse, respiration, skin color, skin temperature, pupils, and blood pressure
Answer: C
Explanation: A) INCORRECT. There a several other vital signs obtained during a standard set.
B) INCORRECT. Bowel sounds are not part of a standard set of prehospital vital signs.
C) CORRECT. The standard vital signs obtained by an EMT are; pulse and respiratory rates,
skin color, temperature and condition, pupil size, equality and reaction, and blood pressure.
D) INCORRECT. This list is missing one standard vital sign that must be assessed by the EMT.
Page Ref: 309
Objective: 13.2
4
11) Breathing sounds that should concern the EMT are:
A) snoring, gurgling, wheezing, crowing, and crowning.
B) retractions, and diaphragmatic breathing.
C) tachycardia, retractions, and diaphragmatic breathing.
D) snoring, gurgling, wheezing, and crowing.
Answer: D
Explanation: A) INCORRECT. Crowning is a term that refers to a stage of childbirth; it is
unrelated to breathing sounds.
B) INCORRECT. Retractions and diaphragmatic breathing are visual respiratory assessments,
not audible.
C) INCORRECT. Tachycardia refers to the patient's heart rate, and retractions and diaphragmatic
breathing are not breathing sounds.
D) CORRECT. Patients who have snoring, gurgling, wheezing, or crowing breath sounds should
concern the EMT as they indicate respiratory challenges.
Page Ref: 313
Objective: 13.3
12) A(n) ________ set of vital signs is important for critical decision making for the EMT.
A) unbiased
B) accurate
C) complete
D) repeated
Answer: B
Explanation: A) INCORRECT. Vital signs are measured against standards; they are not
subjective or open to bias.
B) CORRECT. An accurate set of vital signs is an important foundation for critical decision
making.
C) INCORRECT. A set of vital signs that are complete but wrong will not benefit the patient or
the EMT.
D) INCORRECT. Although repeated vital signs can be important when making ongoing patient
care decisions, it is not simply repetition that makes them valuable.
Page Ref: 310
Objective: 13.3
5
13) You are assessing a 48-year-old male who is unconscious. The scene is safe and you hear the
patient gurgling. What is your next action?
A) Suction the airway.
B) Insert an airway adjunct.
C) Open the airway with a head tilt.
D) Quickly check the pulse.
Answer: A
Explanation: A) CORRECT. Gurgling sounds usually mean that you need to suction the
patient's airway.
B) INCORRECT. An unresponsive adult patient with gurgling respirations should not receive an
airway adjunct as the first step.
C) INCORRECT. Opening this patient's airway with a head-tilt, chin-lift maneuver as the first
step would not be appropriate.
D) INCORRECT. There would be no benefit in checking this patient's pulse as the next action.
Page Ref: 312
Objective: 13.4
14) You are unable to find a radial pulse on a patient from a motor vehicle crash. You should:
A) listen for heart sounds
B) begin chest compressions.
C) attempt to find the carotid pulse.
D) apply the pulse oximeter.
Answer: C
Explanation: A) INCORRECT. Listening for heart sounds would not be the next step if the
patient's radial pulse cannot be located.
B) INCORRECT. There are many reasons why it might be difficult to feel a radial pulse.
However, that does not mean the patient is pulseless.
C) CORRECT. The carotid pulse would be the next option for measuring the patient's pulse.
D) INCORRECT. There would be no benefit in using a pulse oximeter on this patient after not
being able to locate a radial pulse.
Page Ref: 311
Objective: 13.4
6
15) A patient being transported by ambulance to the hospital can have his blood pressure
measured by which of the following methods?
A) Blood pressure monitor
B) Palpation
C) Auscultation
D) Any of the above
Answer: D
Explanation: A) INCORRECT. There are several acceptable ways to obtain a blood pressure
during transport; one of them is by using a blood pressure monitor.
B) INCORRECT. Of the ways to obtain a blood pressure while transporting a patient; palpation
is one of them.
C) INCORRECT. Blood pressure can be auscultated during transport, but there are other ways to
obtain blood pressure also.
D) CORRECT. During transport, a patient's blood pressure can be obtained through auscultation,
palpation, or with a monitor.
Page Ref: 318
Objective: 13.4
16) You respond to a cafeteria to find an unconscious person with gurgling sounds upon
exhalation and inhalation. What is the probable cause of the respiratory sounds?
A) Cardiac arrest
B) Complete airway obstruction
C) Fluids in the airway
D) Tongue blocking the airway
Answer: C
Explanation: A) INCORRECT. There is nothing to indicate cardiac arrest as the cause for these
respiratory sounds.
B) INCORRECT. If the patient had a complete airway obstruction, there would be no exhalation
or inhalation.
C) CORRECT. Gurgling breath sounds normally indicate fluids in the patient's airway.
D) INCORRECT. A tongue occlusion of the airway will often cause snoring respirations.
Page Ref: 313
Objective: 13.4
7
17) How often should a patient's vital signs be reassessed during transport to the hospital after he
has had his pulse restored with CPR and the use of an AED?
A) Every 10 minutes
B) Every 15 minutes
C) Every 2 minutes
D) Every 5 minutes
Answer: D
Explanation: A) INCORRECT. Reassessing vitals every 10 minutes on a post-cardiac arrest
patient would not be proper care.
B) INCORRECT. Only stable patients should have vitals reassessed every 15 minutes; this
patient is not stable.
C) INCORRECT. Taking this patient's vital signs every 2 minutes is not practical.
D) CORRECT. A resuscitated patient is considered unstable; vital signs should be reassessed
every 5 minutes.
Page Ref: 322
Objective: 13.4
18) Where do baseline vital signs fit into the sequence of patient assessment?
A) Ongoing assessment
B) At primary assessment
C) At secondary assessment
D) At the patient's side
Answer: C
Explanation: A) INCORRECT. The term ongoing assessment is generally no longer used in
prehospital care.
B) INCORRECT. The primary assessment is where immediate life threats are found and treated;
baseline vitals are not gathered at this point.
C) CORRECT. During the secondary assessment, the EMT will obtain the first (or baseline) set
of vital signs.
D) INCORRECT. Although the EMT must obviously be near the patient to obtain vitals, the
physical location in relation to the patient is usually defined by the situation.
Page Ref: 307
Objective: 13.4
19) Vital signs should be reassessed every ________ minutes for a stable patient.
A) 15
B) 10
C) 5
D) 20
Answer: A
Explanation: A) CORRECT. Stable patients need repeat vital signs at least every 15 minutes.
B) INCORRECT. Repeating vitals every 10 minutes would be unnecessary for a stable patient.
C) INCORRECT. Critical patients should have vital signs reassessed every 5 minutes.
D) INCORRECT. Waiting 20 minutes between vital sign reassessments would not be proper
care, even when caring for a stable patient.
Page Ref: 322
Objective: 13.4
8
20) Recording and documenting your patient's first set of vital signs is very important because,
when combined with reassessments, it allows you to do which of the following?
A) Make an accurate diagnosis of the patient's illness.
B) Compare your patient's condition with other patients' conditions.
C) Discover trends and changes in the patient's condition.
D) Fill in all of the blanks on the patient care report form.
Answer: C
Explanation: A) INCORRECT. Emergency responders do not diagnose patients.
B) INCORRECT. There is generally no benefit in comparing one patient to another.
C) CORRECT. Determining a baseline set of vital signs and repeating them over time shows any
changes in the patient's condition.
D) INCORRECT. Taking and trending vital signs are much more important than just completing
a PCR.
Page Ref: 309
Objective: 13.5
21) In a conscious adult patient, which of the following pulses should be assessed initially?
A) Brachial
B) Radial
C) Carotid
D) Pedal
Answer: B
Explanation: A) INCORRECT. In an infant who is 1 year old or less, you should find the
brachial pulse in the upper arm first.
B) CORRECT. During the determination of vital signs, you should initially find a radial pulse in
patients 1 year of age and older.
C) INCORRECT. Only when you cannot palpate the preferred initial pulse location should the
carotid be used.
D) INCORRECT. A pedal pulse would not be assessed first in any patient.
Page Ref: 311
Objective: 13.6
9
22) You are assessing a 55-year-old male complaining of chest pain and have determined that his
radial pulse is barely palpable. You also determine that there were 20 pulsations over a span of
30 seconds. Based on this, how would you report this patient's pulse?
A) Pulse 20, weak, and regular
B) Pulse 20 and weak
C) Pulse 40 and weak
D) Pulse 40, weak, and irregular
Answer: C
Explanation: A) INCORRECT. The pulse rate should be reported based on the number of heart
beats in one minute; as for regularity, there is not enough information provided.
B) INCORRECT. Although the pulse would be reported as weak in this situation, the patient's
pulse rate is not 20.
C) CORRECT. The 20 pulsations counted in 30 seconds would be doubled to obtain a per
minute pulse rate.
D) INCORRECT. There is no indication that the patient's rhythm is irregular.
Page Ref: 311
Objective: 13.6
23) The increase in the work of breathing is reported as:

A) labored breathing.
B) troubled breathing.
C) noisy breathing.
D) obstructed breathing.
Answer: A
Explanation: A) CORRECT. When a patient is struggling to breathe, usually accompanied by
accessory muscle use and retractions, it is called labored.
B) INCORRECT. Troubled breathing is not a commonly used medical term.
C) INCORRECT. A patient can struggle to breathe without it being noisy.
D) INCORRECT. The term obstructed indicates a blockage, which may or not be present in a
patient who is working hard to breathe.
Page Ref: 313
Objective: 13.6
10
24) You are called to care for a child who has fallen out of a third-story window. You arrive to
find the child in his mother's arms. As you approach, you notice the child's skin is pale with dark
spots of cyanosis. You would report this uncommon condition of blotchy skin as:
A) mottling.
B) flushed.
C) jaundiced.
D) cyanotic.
Answer: A
Explanation: A) CORRECT. An uncommon skin coloration is mottling, a blotchy appearance
that sometimes occurs in patients, especially children and the elderly, who are in shock.
B) INCORRECT. Skin described as flushed is uniformly red in appearance and generally occurs
due to heat.
C) INCORRECT. Jaundice gives skin and eyes a yellow appearance and is caused by liver
abnormalities.
D) INCORRECT. Hypoxia causes skin to appear bluish or sometimes gray, which is called
cyanosis.
Page Ref: 314
Objective: 13.6
25) The term cyanosis is used when the patient's skin color is noted to be which of the following
characteristics?
A) Yellow
B) Blue-gray
C) Very pale
D) Flushed
Answer: B
Explanation: A) INCORRECT. Jaundice gives skin and eyes a yellow appearance and is caused
by liver abnormalities.
B) CORRECT. Cyanotic skin will have a blue-gray appearance.
C) INCORRECT. Skin that is pale is not described as cyanotic.
D) INCORRECT. The term flushed in reference to skin appearance means that it is red, which is
not cyanotic.
Page Ref: 314
Objective: 13.6
11
26) Which of the following is the BEST way to assess a patient's skin temperature?
A) Place your cheek against the patient's forehead.
B) Place the back of your hand against the patient's forehead.
C) Place your cheek against the patient's abdomen.
D) Place the back of your hand against the patient's abdomen.
Answer: B
Explanation: A) INCORRECT. It would not be following proper body substance protection
guidelines to place your cheek on the patient's forehead.
B) CORRECT. To determine skin temperature, feel the patient's forehead with the back of your
hand.
C) INCORRECT. Placing your cheek against a patient's abdomen would be inappropriate.
D) INCORRECT. The patient's abdomen is not the best place to determine skin temperature.
Page Ref: 314
Objective: 13.6
27) Your patient is in late stages of liver failure and has requested to be transported to the
emergency department. You take your body substance isolation and move him to your cot and
notice his skin is warm and dry with a yellow color. Your radio report to the hospital should state
your patient is:
A) flushed.
B) mottled.
C) jaundiced.
D) cyanotic.
Answer: C
Explanation: A) INCORRECT. When skin appears red it is called flushed.
B) INCORRECT. Mottling, a blotchy appearance that sometimes occurs in patients, especially
children and the elderly, who are in shock.
C) CORRECT. Some liver abnormalities can cause patients to have a yellow skin coloration,
which is called jaundice.
D) INCORRECT. Cyanosis is a blue-gray skin color caused by hypoxia.
Page Ref: 314
Objective: 13.6
12
28) When the EMT checks the pupils he or she is checking for what three things?
A) Movement, gaze, and equality
B) Color, equality, and reactivity
C) Reactivity, gaze, and equality
D) Size, equality, and reactivity
Answer: D
Explanation: A) INCORRECT. Movement and gaze are not assessed by an EMT when checking
pupils.
B) INCORRECT. The color of a patient's eyes is not commonly checked when assessing the
pupils.
C) INCORRECT. An EMT is not assessing for gaze when checking pupils.
D) CORRECT. When you check pupils, you should look for three things: size, equality, and
reactivity (reacting to light by changing size).
Page Ref: 316
Objective: 13.6
29) What is the normal response of the pupils when exposed to bright light?
A) Fluttering
B) Dilation
C) Constriction
D) No effect
Answer: C
Explanation: A) INCORRECT. Pupils should not flutter when exposed to light.
B) INCORRECT. Growing larger when exposed to bright light is not a normal pupillary
response.
C) CORRECT. Normally, pupils will constrict when exposed to light.
D) INCORRECT. Pupils that do not react to bright light are commonly referred to as fixed; it is
not a normal finding.
Page Ref: 315
Objective: 13.6
30) Which of the following is NOT a cause of unequal pupils?

A) Fright
B) Artificial eye
C) Stroke
D) Eye injury
Answer: A
Explanation: A) CORRECT. Fear will not cause a person's pupils to be unequal.
B) INCORRECT. Since artificial eyes do not react to light, it is not uncommon to find unequal
pupils in patients who have them.
C) INCORRECT. A stroke of brain injury can cause pupils to become unequal.
D) INCORRECT. Certain eye injuries can cause the pupil to react differently than the uninjured
eye.
Page Ref: 315-316
Objective: 13.6
13
31) Which of the following BEST describes the proper placement of the blood pressure cuff?
A) Covering two-thirds of the upper arm
B) Midway between the elbow and shoulder
C) One inch below the armpit
D) Covering the patient's elbow
Answer: A
Explanation: A) CORRECT. The cuff should cover two-thirds of the upper arm, elbow to
shoulder.
B) INCORRECT. A cuff placed midway between the elbow and shoulder would not be correct.
C) INCORRECT. Using a measurement of one inch below the armpit would cause the cuff to be
placed incorrectly on some patients.
D) INCORRECT. Placing the cuff over the patient's elbow would not give a proper blood
pressure reading.
Page Ref: 318
Objective: 13.6
32) You are called to a 72-year-old patient with weakness and headache with an initial blood
pressure of 140/92. Her repeat blood pressure at 5 minutes is unchanged. Her condition is called:
A) stroke.
B) prehypertension.
C) hypertension.
D) hypotension.
Answer: C
Explanation: A) INCORRECT. There is no specific indication that this patient has suffered a
stroke.
B) INCORRECT. Readings between the limits of 121 to 139 mmHg systolic and 81 to 89 mmHg
diastolic indicate a condition sometimes called prehypertension.
C) CORRECT. If an adult has a systolic pressure of 140 mmHg or greater or a diastolic pressure
of 90 mmHg or greater, the person has hypertension.
D) INCORRECT. Hypotension is the condition when a patient's systolic pressure falls below 90
mmHg.
Page Ref: 318
Objective: 13.6
14
33) What are the three ways to take blood pressure?
A) Sphygmomanometer, blood pressure monitor, and heart monitor
B) Palpation, auscultation, and blood pressure monitor
C) Sphygmomanometer, auscultation, and blood pressure monitor
D) Auscultation, palpation, and osculation
Answer: B
Explanation: A) INCORRECT. A heart monitor would not be used to obtain a blood pressure.
B) CORRECT. Three common techniques are used to measure blood pressure with a
sphygmomanometer: auscultation, palpation, and blood pressure monitor.
C) INCORRECT. A sphygmomanometer is the device used when taking a blood pressure,
regardless of the method used with it.
D) INCORRECT. Osculation is not a term associated with taking blood pressure.
Page Ref: 318
Objective: 13.6
34) All of the following are common techniques for measuring blood pressure, except:
A) Palpation
B) Rhythm method
C) Blood pressure monitor
D) Auscultation
Answer: B
Explanation: A) INCORRECT. Determining blood pressure by palpation is an effective method
when it is too loud to auscultate the pressure.
B) CORRECT. There is no commonly accepted blood pressure technique called the rhythm
method.
C) INCORRECT. Blood pressure monitors are used in many EMS systems to obtain patient
blood pressures.
D) INCORRECT. Auscultation is the most common method for measuring blood pressure.
Page Ref: 318
Objective: 13.6
15
35) To determine blood pressure, the EMT should position the cuff over the upper arm and place
the stethoscope over the brachial artery. Next, she should inflate the cuff, then slowly deflate the
cuff, listening for clicks or tapping sounds while remembering the number at the first sound.
What is the next step in taking a blood pressure?
A) Dump all the pressure and record the number as the diastolic pressure.
B) Re-inflate the cuff on the patient's arm and repeat the process to verify the reading.
C) Continue releasing pressure until the clicks or tapping stop, and record both numbers. These
are the blood pressure.
D) Remove the cuff from the patient's arm, place it on the opposite arm, and repeat the process to
verify the reading.
Answer: C
Explanation: A) INCORRECT. Dumping the pressure at that point would not give you an
accurate diastolic.
B) INCORRECT. Re-inflating the cuff after obtaining the systolic reading would serve no
purpose.
C) CORRECT. The systolic number is the gauge reading when the sounds start, and the diastolic
number is the reading when the sounds stop; both are needed.
D) INCORRECT. There is generally no reason to repeat a blood pressure on the patient's other
arm, and it would not be the next step in this situation.
Page Ref: 321
Objective: 13.6
36) You are attempting to assess the blood pressure of a 35-year-old male at the scene of a
multiple vehicle collision. The scene is very noisy and you are unable to clearly hear the patient's
heartbeat. You should:
A) use an automatic blood pressure machine.
B) obtain the blood pressure by palpation.
C) try using the patient's other arm.
D) have your partner try auscultating the blood pressure.
Answer: B
Explanation: A) INCORRECT. An automatic blood pressure machine would not be the next
best option in this situation.
B) CORRECT. EMTs often work in environments that make auscultation difficult. Measuring
blood pressure by palpation would be the most appropriate alternative in this situation.
C) INCORRECT. Switching arms will not make the environment less noisy.
D) INCORRECT. If the environment is too loud to auscultate a heartbeat, it would potentially
waste time to have others try hearing it.
Page Ref: 318
Objective: 13.6
16
37) You are transporting a patient down a bumpy road. Your patient's blood pressure has just
been measured by the monitor to be 190/110. The patient's blood pressure on scene was 130/80.
You should:
A) ignore the blood pressure reading.
B) have the driver increase truck speed.
C) apply the automatic cuff to the other arm.
D) re-measure the blood pressure manually.
Answer: D
Explanation: A) INCORRECT. The reading should not be ignored because it may indicate a
change in the patient's condition.
B) INCORRECT. Increasing the speed on a bumpy road will not make the monitor more
accurate.
C) INCORRECT. If the bumpy road is causing the monitor to misread the blood pressure,
changing arms will not make a difference.
D) CORRECT. Automatic blood pressure machines can be unreliable on bumpy roads. Before
making any decisions based on the patient's blood pressure, it is important to verify such a
drastic change using a more accurate method.
Page Ref: 321-322
Objective: 13.6
38) When taking blood pressure, the cuff should be inflated to what point?
A) 30 mmHg beyond the point where the pulse disappears
B) Until the patient says it hurts
C) Until the Velcro starts to crackle
D) Until the gauge reads 200 mmHg
Answer: A
Explanation: A) CORRECT. The blood pressure cuff should be inflated 30 mmHg past the point
where the radial pulse disappears.
B) INCORRECT. The patient complaining of pain from the cuff is not the gauge for knowing
when to stop inflating it.
C) INCORRECT. The Velcro can crackle randomly during use of the cuff. It is not a good
indicator for when to stop inflating it.
D) INCORRECT. Inflation of the cuff may or may not need to be stopped when the gauge reads
200 mmHg, it depends on the patient.
Page Ref: 321
Objective: 13.6
17
39) You are transporting a patient to the hospital from a motor vehicle crash. Your patient's
initial blood pressure was 88/52. You should reassess blood pressure:
A) at least every 5 minutes.
B) at least every 15 minutes.
C) only if the pulse rate changes.
D) only if the patient gets worse.
Answer: A
Explanation: A) CORRECT. Patients with vital signs that suggest instability should have their
vital signs reassessed at least every 5 minutes.
B) INCORRECT. Only stable patients should have vitals reassessed every 15 minutes; this
patient is not stable.
C) INCORRECT. Reassessment standards for vitals are not based on pulse changes.
D) INCORRECT. It may be hard to determine if the patient is getting better or worse without
reassessing vital signs.
Page Ref: 322
Objective: 13.6
40) The device that some EMS services use as a light wave device to measure oxygen saturation
(SpO2) is called a(n):
A) capnography.
B) sphygmomanometer.
C) end tidal CO2 meter.
D) pulse oximeter.
Answer: D
Explanation: A) INCORRECT. Capnography measures carbon dioxide, not oxygen.
B) INCORRECT. A sphygmomanometer is used to measure blood pressure.
C) INCORRECT. Carbon dioxide is measured by an end tidal CO2 meter.
D) CORRECT. A pulse oximeter is commonly used to measure oxygen saturation.
Page Ref: 324
Objective: 13.6
18
41) You are assessing an 82-year-old female that has been lost in the woods behind her nursing
home for several hours on a crisp fall evening. Your pulse oximeter shows her oxygen saturation
to be 82% even though she appears to be breathing adequately. In order to ensure an accurate
reading you should:
A) try a different pulse oximeter.
B) place the probe on the patient's toe.
C) place the probe on the patient's earlobe.
D) warm the patient's hands and try again.
Answer: D
Explanation: A) INCORRECT. Based on the patient's presentation and immediate history, it is
probable that the pulse oximeter being used is not the problem.
B) INCORRECT. A standard pulse oximeter used in EMS is not designed for use on toes and
even if it were, based on the patient's presentation, the reading probably would be similar.
C) INCORRECT. Placing the probe on the patient's earlobe would most likely not be any more
effective.
D) CORRECT. The pulse oximeter may not be accurate if the extremity being used is cold.
Warming the extremity should produce a better reading.
Page Ref: 325
Objective: 13.6
42) Your patient is warm, dry, pink, and denies shortness of breath. Which of the following
should the EMT expect to find when evaluating the patient's oxygen saturation?
A) 91%
B) 98%
C) 102%
D) 95%
Answer: B
Explanation: A) INCORRECT. A patient with 91% oxygen saturation would be suffering from
mild hypoxia and would not present as this patient does.
B) CORRECT. The patient is obviously not hypoxic, so the oxygen saturation should be in the
normal range.
C) INCORRECT. A patient cannot have an oxygen saturation higher than 100%.
D) INCORRECT. Oxygen saturation of 95% is mild hypoxia; a hypoxic patient would not
present with warm, dry and pink skin, and most likely would have shortness of breath.
Page Ref: 324
Objective: 13.6
19
43) The range of normal blood glucose level is from a low of 60 to 80 mg/dL to a high of:
A) 110 to 130.
B) 100 to 120.
C) 90 to 100.
D) 120 to 140.
Answer: D
Explanation: A) INCORRECT. A normal glucose reading can be higher than 110 to 130.
B) INCORRECT. It is not uncommon for a normal glucose reading to be higher than 100 to 120.
C) INCORRECT. A normal blood glucose level can be higher than 100.
D) CORRECT. A normal blood glucose level is usually at least 60 to 80 mg/dL and no more
than 120 or 140.
Page Ref: 327
Objective: 13.6
44) You are about to apply a blood pressure cuff to an unconscious patient when you notice that
she appears to have a tube underneath the skin of her arm. The tube feels like it has fluid going
through it. You should:
A) move the cuff down to the forearm and inflate.
B) continue to take her blood pressure in the arm.
C) find another site to measure her blood pressure.
D) use an automatic blood pressure cuff instead.
Answer: C
Explanation: A) INCORRECT. It would not be appropriate to use that arm for a blood pressure;
it is possible that the patient has a dialysis shunt or other device implanted.
B) INCORRECT. This patient has a dialysis shunt or some other artificial device in her arm.
Inflating a blood pressure cuff in that arm could damage the device and perhaps cause internal
bleeding.
C) CORRECT. Switching to the other arm or a thigh would be much safer than attempting to use
the original arm.
D) INCORRECT. Regardless of the type of cuff used, an arm that appears to have a shunt or
other implanted device should not be used to obtain a blood pressure.
Page Ref: 318; 321
Objective: 13.7
20
45) Your patient has a heart rate of 82, a respiratory rate of 16, and a blood pressure of 120/80
and does not appear to be in any distress. You should repeat vital sign measurements at least
every:
A) 5 minutes.
B) 10 minutes.
C) 15 minutes.
D) 20 minutes.
Answer: C
Explanation: A) INCORRECT. This patient is stable; there is no reason to reassess vitals every
5 minutes with stable patients.
B) INCORRECT. Vital sign reassessments every 10 minutes are not standard for stable or
unstable patients.
C) CORRECT. Vital signs should be reassessed at least every 15 minutes in stable patients.
D) INCORRECT. It would be inappropriate to wait 20 minutes before reassessing vital signs
with any patient.
Page Ref: 322
Objective: 13.8
46) Which of the following is a normal respiratory rate for an adult at rest?
A) 12 breaths per minute
B) 10 breaths per minute
C) 24 breaths per minute
D) 22 breaths per minute
Answer: A
Explanation: A) CORRECT. An adult at rest should have a respiratory rate of 12 breaths per
minute.
B) INCORRECT. 10 breaths per minute would be too slow to be considered normal.
C) INCORRECT. An adult patient with 24 breaths per minute while at rest is in respiratory
distress.
D) INCORRECT. 22 breaths per minute is considered too rapid for a healthy adult at rest.
Page Ref: 312
Objective: 13.8
21
47) You have a 38-year-old patient who has fainted. Following your local protocol you use a
light wave device to determine the SpO2. As the EMT, you attach the device on the patient's
finger, which gives you a reading of 91. What does that reading indicate?
A) Significant hypoxia
B) Severe hypoxia
C) Normal results
D) Mild hypoxia
Answer: D
Explanation: A) INCORRECT. A reading of 86 to 90% indicates significant or moderate
hypoxia.
B) INCORRECT. A SpO2 of 85% or less indicates severe hypoxia.
C) INCORRECT. A normal SpO2 is between 96 and 100%.
D) CORRECT. An oxygen saturation reading between 91 and 95% is considered to be mild
hypoxia.
Page Ref: 324
Objective: 13.8
48) When pupils are dilated they are:

A) elliptical or elongated in shape.
B) smaller than normal.
C) larger than normal.
D) irregularly shaped.
Answer: C
Explanation: A) INCORRECT. Pupils are generally round, no matter what size they are.
B) INCORRECT. Smaller than normal pupils are called constricted.
C) CORRECT. When a pupil dilates it gets larger than normal.
D) INCORRECT. An irregularly-shaped pupil would not necessarily be referred to as dilated.
Page Ref: 315
Objective: 13.8
49) Slight movement of the chest during respiration is usually indicative of which of the
following?
A) Labored breathing
B) Normal breathing
C) Noisy breathing
D) Shallow breathing
Answer: D
Explanation: A) INCORRECT. Labored breathing will present with excessive chest movement,
including accessory muscle use and retractions.
B) INCORRECT. A patient whose chest expands an average distance during inhalation is
considered to be breathing normally.
C) INCORRECT. The sounds associated with breathing can be unrelated to chest movement.
D) CORRECT. Shallow breathing occurs when there is only slight movement of the chest or
abdomen.
Page Ref: 313
Objective: 13.8
22
50) An inaccurate oxygen saturation reading can result in all of the following except:
A) carbon monoxide inhalation.
B) a patient that smokes cigarettes.
C) a patient wearing fingernail polish.
D) Any of the above
Answer: D
Explanation: A) INCORRECT. There are several things that can make an oxygen saturation
reading inaccurate; carbon monoxide exposure is one of them.
B) INCORRECT. Smoking cigarettes can sometimes cause false oxygen saturation readings, but
there are several other things that can also cause them.
C) INCORRECT. It may occasionally be difficult to get an accurate oxygen saturation reading if
the patient is wearing fingernail polish, but there are several other factors that can also cause
inaccuracies.
D) CORRECT. Cigarette smoking, carbon monoxide poisoning, and fingernail polish can also
result in inaccurate oxygen saturation readings.
Page Ref: 325-326
Objective: 13.8
51) You respond to a 30-month-old patient who has passed out. Is the patient's blood pressure
important to your treatment and why?
A) Yes, blood pressure must be taken on everyone because without it we cannot impact the
patient's field management.
B) No, blood pressure taken on children younger than age 3 can cause damage to the tender
tissues of the arm that could lead to hypertension in later life.
C) Yes, blood pressure can be taken on children because it is the only way we can understand the
patient's condition.
D) No, blood pressure taken on children younger than age 3 is difficult and has little impact on
the patient's field management.
Answer: D
Explanation: A) INCORRECT. Blood pressures are not relevant on a patient this young.
B) INCORRECT. Obtaining a blood pressure on a young child has not been shown to affect
hypertension later in life.
C) INCORRECT. Assessing a child's condition is not commonly dependent on blood pressure.
D) CORRECT. Blood pressures are difficult to obtain with any accuracy on infants and children
younger than 3 and have little bearing on the patient's field management.
Page Ref: 322
Objective: 13.9
23
52) An approximate normal systolic blood pressure can be calculated for infants and children by
using which of the following formulas?
A) 80 plus 2 times the age in years
B) 120 plus 2 times the age in years
C) 120 minus 2 times the age in years
D) 80 times 2 plus the age in years
Answer: A
Explanation: A) CORRECT. The approximate normal systolic pressure for an infant or child is
calculated by multiplying the patient's age by 2 and adding 80.
B) INCORRECT. The systolic pressure of a child or infant is not estimated by adding 120 to the
age times 2.
C) INCORRECT. Multiplying a child's age times 2 and subtracting 120 would not give an
approximate systolic pressure.
D) INCORRECT. Multiplying 80 times 2 and adding the patient's age does not give an
approximate systolic pressure for pediatric patients.
Page Ref: 317
Objective: 13.9
53) If capillary refill is assessed in a child patient, how long should it take the normal pink color
to return to the nail bed?
A) 2 seconds
B) 4 seconds
C) 3 seconds
D) 5 seconds
Answer: A
Explanation: A) CORRECT. If it takes longer than 2 seconds for the color to return to a
pediatric patient's nail beds the blood is probably not circulating well.
B) INCORRECT. It should not take as long as 4 seconds for the color to return to the child's nail
beds.
C) INCORRECT. If it takes 3 seconds for the color to return, the patient's blood may not be
circulating properly.
D) INCORRECT. Five seconds is far too long for the nail bed color to return in a normal
pediatric patient.
Page Ref: 314
Objective: 13.9
24
54) What category would include a patient with a blood pressure of 134/84 mmHg?
A) Hypotension
B) Normotension
C) Hypertension
D) Prehypertension
Answer: D
Explanation: A) INCORRECT. Hypotension is generally considered to exist when the systolic
pressure falls below 90 mmHg.
B) INCORRECT. A normal blood pressure is a systolic pressure of no greater than 120 mmHg
and a diastolic pressure of no greater than 80 mmHg.
C) INCORRECT. If an adult has a systolic pressure of 140 mmHg or greater or a diastolic
pressure of 90 mmHg or greater, the person has hypertension.
D) CORRECT. Readings between the limits of 121 to 139 mmHg systolic and 81 to 89 mmHg
diastolic indicate a condition sometimes called prehypertension.
Page Ref: 318
Objective: 13.9
55) You respond to a childcare center for a report of an injured 4-year-old. Her pulse is 130 beats
per minute. Which of the following BEST describes this finding?
A) Bradycardic
B) Normal for the child's age
C) Tachycardic
D) Unable to determine without knowing the family history
Answer: C
Explanation: A) INCORRECT. A 4-year-old with a pulse of 130 would not be considered
bradycardic.
B) INCORRECT. 130 beats per minute is not normal for a 4-year-old child.
C) CORRECT. A heart rate above 120 in a 4-year-old patient would be considered tachycardic.
D) INCORRECT. The patient's family history has nothing to do with describing a pulse rate
finding.
Page Ref: 310
Objective: 13.9
25
Another random document with
no related content on Scribd:
“Answer me one question,” Walter gasped, for his breath came so
thick and fast that he could scarcely speak. “Did you tell Miss
Meredith of my disguise?”
“No; it did not occur to me to do so.”
“I see it now clear enough,” he continued. “She has been here. The
voice I heard was hers. She did not recognise me in this disguise,
and fled.”
“I think there can be no doubt that these are the true facts,” Mehal
remarked. “And it must have been on leaving the shed that she was
recaptured.”
Walter was bowed with grief. He felt that incalculable misery had
been brought upon all by one of the merest chances imaginable.
Flora might have been saved; but in the very moment of her
extremest peril he had been sleeping; and to that circumstance was
due the fact that she was again lost to him. It was a terrible
reflection. But useless wailings could avail nothing; action—prompt
action—was required.
“Zeemit,” he cried, “at all hazards I will follow Miss Meredith. To
rescue her is the mission of my life. I must accomplish it or perish!”
“Were you to follow her, you would most certainly perish. It would be
a useless sacrifice of your life, and you would not be able to render
her the slightest aid. At a time like this, when the power of your
countrymen is set at defiance, and anarchy prevails, stratagem only
can succeed. To that we must resort!”
“But what do you propose?” he exclaimed, interrupting her in his
eagerness.
“I propose to follow her myself. I, and I alone, can save her now.”
“But what shall I do?” he asked, scarcely able to restrain his
impatience.
“You must remain quiet. I go to Delhi ostensibly on Jewan Bukht’s
behalf. I have told him that I shall endeavour to liberate Miss
Meredith, so that she may again fall into his hands. Your presence
would endanger my plans, and you would run the risk of being
detected. Make your way to the English defences in this town. I will
find means of communicating with you in a few days; and, should I
succeed in setting the lady free, we will instantly proceed to Meerut,
where you can rejoin us, or we will come on here.”
“I am in your hands, Mehal; I will be guided by you. But remember, if
I do not hear from you in about a week I shall endeavour to make my
way to Delhi, whatever the consequences may be. To remain
inactive when her honour and safety are imperilled, would be a living
death. Therefore I will face any danger, so that I can feel that I am
doing something in her behalf.”
“You can best aid her by doing what I suggest. On reaching Delhi, if I
find it practicable to set her free, I will return here immediately to let
you know; the rest must depend upon circumstances. Jewan will be
able to get me a conveyance back to Delhi, so that I will soon be with
Miss Meredith once again. I cannot remain longer with you, for if
Jewan should miss me all our plans would be frustrated, and he
would kill me.”
Walter saw the necessity of strictly complying with the old woman’s
wishes. He recognised that in her rested every hope of future
happiness. It was a slender reed, but the only one upon which he
could lean.
Mehal gave him some hurried directions as to the road to take to
reach the English quarters, and then hastened away; and he was left
standing alone, as the rising sun was commencing to throw down his
fiery beams.
CHAPTER XXI.
THE VOICE OF THE CHARMER.
As Walter Gordon and Zeemit Mehal arranged their plans, and then
separated in the hope of speedily meeting again, they little dreamt of
the mine upon which they stood. The woman was as ignorant of the
true state of Cawnpore as Walter himself. She had no idea that all
was ready for the revolt, and that in a few hours all the horrors of the
mutiny would be visited upon the devoted heads of the little handful
of English in the city. But the ways of Providence are mysterious.
From a human point of view, all things might have been ordered
differently; but it was ordained otherwise—ordained for some special
purpose that the cups of sorrow of some of the people in the city was
to be filled to overflowing ere relief came; and to this Walter Gordon
was to be no exception. When Zeemit had disappeared, he left the
shed which had for the time given him shelter and security, and with
heavy heart he set his face towards the British quarters. He had little
difficulty in finding his way on to the high road. And though he was
frequently accosted by the passing natives, he made motions to all
that he was dumb; he was thus enabled to pass on unmolested; but
as he went, he gathered scraps of information, which left him no
doubt that the troops were on the eve of rising.
When he reached the outlying sentries of the British defences, he
was stopped; but he speedily made known his nationality to the man
who challenged him, and was allowed to pass on.
He lost no time in seeking out Sir Hugh Wheeler, and soon related
his story to the General, who was no less pained than he was
astonished.
“I think the old woman has counselled you well,” Sir Hugh remarked
as Walter finished. “You could not hope to bring this English lady out
of Delhi yourself, and Mehal may succeed. At any rate, it is your only
chance. Last night a wounded officer and a native woman, who have
escaped from the Imperial City, were brought in here. The officer,
who is from Meerut, had been shot within a mile or two of this place.”
“Indeed!” exclaimed Gordon, in astonishment, as the idea occurred
to him that the English officer from Meerut could be no other than his
friend Harper. “Do you know the officer’s name?”
“Harper, I believe; a lieutenant in the Queen’s —— regiment.”
“This is strange, indeed. The lieutenant is an old friend of mine, and
with your permission I will see him immediately.”
“Do so by all means. I had an interview with him this morning, and
though he is very ill, he was enabled to inform me that he had been
sent to Delhi on special service, that he had there been made a
prisoner, but effected his escape through the assistance rendered
him by a Cashmere lady, who is here with him. I am anxious that he
should be forwarded on to his regiment at Meerut without loss of
time; but the doctor says it would be dangerous to move him for
some days.”
In a few minutes Walter Gordon stood by the bedside of his friend
Harper, who had fallen into a troubled sleep. At the head was seated
the faithful Haidee, and she was applying iced water to the forehead
of the patient.
Gordon soon made himself known to her, and she briefly told him the
history of his friend since they had parted—a space of time brief
enough in itself, but filled with suffering and sorrow for them all.
Harper was deathly pale, his eyes were sunken; he had been
severely wounded. The ball had entered the left breast, glanced
along one of the ribs, narrowly escaping the heart, and ultimately
lodged beneath the shoulder-blade. No vital organ had been
touched; but there was considerable inflammation, and the doctors
were not without anxiety for the condition of their patient. They had
not yet extracted the ball, owing to his weakened state.
Haidee watched every change of countenance, noted every beat of
his pulse, for she scarcely ever moved her fingers from his wrist. It
was certain that, if loving care could save him, his life would not be
sacrificed.
Gordon was anxious to know who Haidee was; but he did not like to
question her, and she did not volunteer the information. He was
afraid to think evil of his friend, and yet he was at a loss to account
for Haidee’s presence.
Presently Harper turned uneasily on the bed, then he opened his
eyes and stared at Gordon, who put out his hand to shake that of his
friend. But Harper only stared—there was no recognition—the light
of reason was for a time out of his eyes, and he was delirious.
The little band of defenders were now thrown into commotion by the
arrival of a messenger who brought word that the rising had
commenced, that the gaol had been thrown open, and the treasury
was being sacked.
The news was too true. The hour of the Nana’s triumph had arrived.
He had given the word, and his followers at the Newab-gung had
broken open the gaol and set the prisoners free. Then they cleared
out the magazine, and a wealth of heavy artillery and ammunition fell
into their hands.
The spoil from the treasury was heaped upon elephants and carts,
and the infuriated soldiery, feeling themselves unfettered at last,
cried—
“Forward to the Imperial City!”
They, like the Meerut mutineers, expected great things from the
restored sovereignty; upon the restoration of the Mogul throne they
placed all their hopes.
But this was not the case with Nana Sahib, nor the wily Azimoolah.
The centralisation of the rebellion was to place the power in one pair
of hands. The Nana craved for power, and he had no intention of
recognising the authority of the King, to whom he would have to be
subordinate. That, however, formed no part of his programme. But,
for a time, the Sepoy leaders declared their intention of going to
Delhi, and they made one short march on the road as far as a place
called Kullianpore. Here, with all their elephants ladened with the
English treasure, their artillery, and heaps of ammunition, they
halted. The Nana had accompanied them thus far. He knew that by
humouring their first impulse he might bend them to his will. His craft
and cunning were truly remarkable.
“Comrades,” he cried, as he commenced to harangue them, “we
make common cause. And I ask you, would you be slaves? If you go
to Delhi your necks must bear the King’s yoke. Remember all that I
have done—all that I have sacrificed to give you liberty. From these
English I drew wealth, but I have forfeited all in order that you may
be free. Why should you go to the Imperial City? If you concentrate
yourselves at any given point, it is certain that the Feringhees will
mass their forces against that point and crush you. It is by spreading
ourselves over a large area that our hopes of success lie. The British
have not troops enough to attack all our strongholds. Again I say,
what can Delhi offer you more than I can? Have we not a fair city
here?
“The power of the English in Europe is declining; they are weak in
India; the vast breadth of country over which the faithful followers of
the Prophet are asserting their independence is stripped of troops.
What then have we to fear? Remain here and recognise my rule.
Restore the Peishwahship, and I promise you wealth, freedom,
honour and glory.”
The voice of the charmer prevailed. The leaders wavered in their
determination. They conferred one with another, then up they spoke,
almost as one man, and answered the Nana Sahib—
“We go back—we devote our lives to your service—we will do your
bidding.”
The Mahratta smiled. He saw that the game was in his own hands,
and that his ambition and malice might be gratified at one blow. Here
were four disciplined native regiments—together with his Bhitoor
retainers, who numbered alone nearly one thousand, and were all
trained soldiers, some hundreds of guns, heaps of ammunition, and
abundance of treasure. With such a force, what might he not do?
His familiar demon, Azimoolah, rubbed his hands with ferocious joy
as he heard the answer of the men. Formerly a common servant in
the house of an Englishman, Azimoolah had been raised to position
by the Nana, to whom he had ever been a ready tool and a cringing
slave. He had gone to England to plead his worthless master’s
cause; he had made love to English ladies; he had been fêted and
lionised by the hospitable English, who loaded him with favours and
presents. But he returned to his country with a deadly hatred in his
heart for those who had befriended him.
In addition to this astute Mahomedan and cunning devil, the Nana
had in his company Tantia Topee, who had been his playfellow in
former days, and was now his counsellor and guide.
There were also Bala Rao and Baba Bhut, his brothers; the Rao
Sahib, his nephew, and Teeka Singh—a combination of cowardly
and pitiless villains.
And so the elephants’ and horses’ heads were turned round again,
the artillery trains were got in motion, and at the head of his powerful
army the Nana Sahib—the ruthless Tiger of Cawnpore—marched
back to the city. He felt that he was supreme master of the situation.
He knew that opposed to him were a little handful of English only,
that he could crush—or, at least, he believed so; but he did not
consider the hearts of steel that beat in the breasts of those few
British, who would have conquered even his legions of black demons
if they had not been made the victims of a cruel plot.
With swelling pride the Nana rode into the town, his long lines of
troops in the rear, his guns lumbering over the dusty roads, and
singing a “song of death” with their trundling wheels. He dubbed his
army at once the “Army of the Peishwah,” and commenced to make
promotions, Teeka Singh being placed in command of the cavalry,
with the rank of general. Azimoolah was war secretary and
counsellor, and Tantia Topee became keeper of the treasure.
When this first business had been arranged to their own satisfaction,
the army sat down close to the British defences. Long a subject of
the English, Nana Sahib now felt that he was their master; and a
pitiless, grinding, exacting, awful master he was to prove.
As he viewed the paltry fortifications which had been thrown up by
General Wheeler, and then let his eyes wander to his own heavy
guns, he smiled a grim smile of satisfaction.
“What think you of our chances of success, Azimoolah?”
“I have been examining the place through my telescope for the last
half-hour,” answered Azimoolah. “I have some difficulty in
discovering their works, even now. But I think that after two hours’
battering with our guns, I shall need a microscope to find them.”
“Sarcastic, as usual, Azi. But don’t you think that we had better let
these miserable people go?”
“Go—go where?” cried the crafty knave, turning upon his master
suddenly.
“Escape,” the Nana answered pointedly.
“Escape?” echoed the other, in astonishment. “Surely your Highness
will not signal the commencement of your reign by an act of namby-
pamby weakness. Escape, forsooth! Turn every gun you’ve got upon
them, and blow them to that hell they are so fond of preaching
about!”
“You do not gather my meaning, Azi,” the Nana replied, as he viewed
the defences through a jewelled opera-glass. “I meant, let them
escape from one trap, to fall into another. We could have them cut to
pieces when they had got some miles from Cawnpore, and we
should escape blame.”
“Oh, oh, your Highness—pardon my hastiness. You are an able
prince. I could not imagine that you were going to spoil your nature
by any stupid, sentimental notions; still, I do not approve of your
Highness’s scheme. We should miss too much sport. And why need
we concern ourselves about the blame? Let us commence the fun
without further delay.”
The Nana laughed heartily, as he replied—
“You are somewhat hasty, my friend. Impetuosity is not good. There
is refinement in killing, as in all other things. The acmé of torture is
suspense. We will torture these British people, Azi. I shall send,
however, a message to Wheeler, that I am going to attack his
entrenchments.”
“But why should your Highness even take this trouble?”
“Because we will so far recognise the usages of war as to announce
our intention to commence the siege.”
In accordance with this determination, a messenger was despatched
to the aged General, who did everything that man could do to make
the best of his position. Darkness had fallen. It gave the brave hearts
behind those mud walls a short respite, but with the return of light the
booming of a gun told that the enemy had commenced operations.
CHAPTER XXII.
THE LION HEARTS.
With the booming of that gun, as the terrible day dawned on

Cawnpore, there commenced a siege that, for horror and misery, has
never been exceeded in the history of the world.
It was the month of June. The heat was terrific. The cloudless sky
was like a canopy of fire. What little wind there was came like the
blast from a glowing furnace. The tubes of the guns grew so hot in
the sun’s rays that it was impossible to touch them with the hand.
Behind the entrenchments were a heroic band of men—a mere
handful—and with them nearly two hundred women and children.
It was for the sake of these dear ones that every man braced himself
up to fight against those fearful odds, until he fell dead at his post.
Not a craven heart beat in any breast there. Every person knew that
the case was hopeless—that to hold out was but to prolong the
agony. But “surrender” was a word no one would breathe.
For days and days went on the awful siege. The defenders, weary,
overworked and starving, laboured, with the might of giants, in the
trenches. The clothes rotted from their backs, and the grime from the
guns caked hard and black upon their faces and hands. But, with
dauntless courage, they served the guns, and this always under a
tremendous fire, from which they were barely screened.
Where all were heroes, comparisons would be invidious indeed, and
yet there were some whose names are indelibly written upon the
scroll of fame, for the conspicuous manner in which they displayed
their heroism.
Captain Moore was one of these. He was wounded at the very
commencement of the siege—his arm was broken. But it could not
break his spirit! He went about with the fractured limb in a sling. No
toil seemed to weary him—no danger could daunt him. Day and
night he laboured; encouraging the women, cheering the children.
Now serving a gun—now heading a desperate sortie against the
enemy. As a companion with him was Captain Jenkins of the 2nd
Cavalry. He held the outposts beyond the trenches. Over and over
again did the enemy try to dislodge him, but failed each time. At
length a treacherous Sepoy, who had been feigning death, raised his
gun and fired. The jawbone of the brave Jenkins was smashed, and
he died an agonising death.
One day a red-hot shot from the enemy’s battery blew up a tumbrel
and set fire to the woodwork of the carriage. A large quantity of
ammunition was stored close by. If this caught fire the whole place,
and every soul in it, would meet with instant destruction. It seemed
as if nothing but a miracle could save them, for there was no water—
nothing to extinguish the flames. But the miracle suddenly appeared
in the person of a young hero; his name was Delafosse. A deadly
stream of eighteen-pound shot was poured upon the spot by the
besiegers, but, unmoved by this, Delafosse flung himself upon the
ground beneath the blazing wood, which he tore off with his hands,
and then stifled out the fire with dry earth. Such a cheer rose from
the throats of the British at this heroic deed, that it must have sent
terror to the hearts of the cruel and cowardly enemy.
Then upon a projection of the barrack wall there was perched young
Stirling, known as the “dead-shot,” from his unerring aim. Day after
day he sat on his perch and picked off single Sepoys. And the list
would be incomplete without mention of the brave Scotchman,
Jervis; he was an engineer. He was out in the open compound one
day, and with the indomitable pride of race, refused to run from a
black fellow, so he fell shot through the heart.
If midst our tears we sing a pæan in honour of these hero-martyrs,
the wives and daughters of the fighting men of Cawnpore must go
down to posterity as an example of all that women should be—noble,
patient, uncomplaining.
Poets have sung how the women of old turned their hair into bow-
strings, that their men might fight the enemy. Those Cawnpore
women would have done the same, if it had been needed. And they
did do an equivalent. When the canister could not be rammed home,
owing to the damage done to the guns by the enemy’s fire, these
noble women took off their stockings. These were filled with the
contents of the shot-cases, and it is probably the only time that such
cartridges were used.
The days lengthened into weeks, but still these lion hearts could not
be quelled. Sadly reduced were their ranks by death; for what the
enemy’s fire failed to do, privations and sickness completed.
One of the greatest wants felt was that of water. The small quantity
in store when the siege began was soon exhausted, and the only
supply to be obtained was from a small well that stood in the open
compound. The cruel enemy knew this, and they kept guns pointed,
and special marksmen for that particular spot. To go for water was to
go to almost certain death. And yet every morning men were found
who volunteered for the awful work, until around the well there grew
up a pile of dead, where they were obliged to be left, for there was
nowhere to bury them.
At last came one of the heaviest blows that had fallen upon the
garrison. The barrack with the thatched roof was burnt down; it had
enjoyed an immunity from this long-expected disaster, but the fatal
shot came one day that set it on fire. How the fiendish hearts of the
coward mutineers beat with joy as they saw the flames leap into the
air! It was a terrible disaster for the noble defenders, as many of the
women and children had to lie upon the bare ground without any
shelter from the dews by night or the sun by day.
Matters had grown desperate enough now. The food was all but
done; the well was all but dry. The air was poisoned by the unburied
dead. Sickness and disease were hourly thinning the number of the
wretched people; and yet there was not a man there, not a woman,
nay, not even a child, who would have consented to dishonourable
surrender.
During the progress of the siege, there was one who was not able to
render much, if any, assistance. This was Lieutenant Harper, who
recovered but slowly from the effects of his wound; the want of
proper nourishment and other necessaries retarded his progress to
convalescence. Haidee watched over him, nursed him with untiring
care, and gradually brought him from the very brink of the grave.
When he gained strength, he felt that the time had come to render
what poor assistance he could. How best could that be done? was a
question he put to Haidee and Gordon, who had been amongst the
most prominent defenders. After some reflection Haidee answered—
“If you could reach the outside world, and procure succour, we might
all be saved.”
It was an unselfish suggestion. She knew that it was a forlorn hope;
but it held out a faint hope for the little garrison. Harper jumped at it.
It was desperate service indeed. To safely get beyond the lines of
the investing army seemed almost out of the region of possibility; but
there was yet a chance, however small, and if he could but reach
Meerut, help might be procured, and the little remnant of the brave
defenders saved.
It was agreed unanimously that he should go, and a dark night
favoured his departure. Walter Gordon would readily have gone, but
he felt that his strength could be utilised to better advantage in
helping the besieged. He had suffered agonies of mind as he
thought of what the fate of Flora Meredith might be. He hoped and
prayed in his own mind that a merciful death had long since ended
her sufferings.
The hour came for Harper to depart; it was a solemn moment. Each
felt that as they grasped hands.
“Walter,” said Harper, “the last time we parted was at the very
commencement of this horrible mutiny. I little thought then that we
should meet again; but we part now, and the chances of our seeing
each other any more on this earth are remote indeed. Though, if I
should survive, and can render aid to Flora Meredith, if she lives, it
shall be done. But before I go, I exact a solemn promise from you,
that while life is in your body you will protect Haidee, and if you
should both manage to escape, you will never lose sight of her.”
“I give the promise, old fellow. God bless you,” was Walter’s answer,
in a voice that was choked with emotion.
Harper turned from his friend to bid farewell to Haidee. How can that
parting be described? There was no passionate wailing—no useless
tears. She was a true woman, and however powerful her love might
be, she knew that it was a duty to sacrifice all personal feelings
where so many lives were at stake. She hung around his neck for a
few brief moments; she pressed a kiss of pure love upon his lips,
and then released him. In both their hearts there was that nameless
feeling of ineffable sorrow that has no interpretation.
“Light of my eyes, joy of my soul, go,” she said. “Into the dust Haidee
will bow her head, for happiness can never more be hers.” One more
pressure of the hand, one more meeting of the lips, and Harper
crouched down, and was making his way across the compound.
It was midnight, and the night was dark. The enemy’s fire had almost
ceased; and as the crouching form disappeared, many were the
fervent prayers uttered on Harper’s behalf, that he would succeed in
his mission.
The morning came, and then the night again, and the next morning,
and so on for several mornings, the defenders holding out bravely.
Meanwhile the Nana Sahib was chafing with rage. He had not
counted upon such a stubborn resistance. The indomitable pluck of
these English was something that passed his comprehension. It
irritated him beyond measure. The city over which he wished to rule
was in a state of turmoil through it. His army was being shattered.
Some of his best Sepoy officers had been killed by the fire from the
defences; and, to make matters worse, cholera had broken out
amongst the troops, and raged violently. Driven to desperation, he
held counsel with his staff.
“What can we do to subdue this people?” he asked of Azimoolah.
“Nothing to subdue them,” was the answer. And for the first time in
his life, perhaps, Azimoolah spoke the truth.
“What shall we do to crush them, then?” the Nana went on; “I would
hack them to mince-meat, if I could get near enough, but that seems
impossible.”
“Scarcely so impossible as your Highness seems to imagine,” made
answer Azimoolah, as his face glowed with the inhuman cruelty that
stirred his heart.
“How shall we reach them?” was the angry question of his master.
“By stratagem.”
“Ah, that is good! But how?”
“These people are reduced to extremity. They have many women
and children with them; for their sakes they will be glad to accept
terms. Let us proclaim a truce, and offer, as a condition of their
laying down their arms, to convey them by water to Allahabad.”
The Nana laughed as he observed—
“You are an excellent counsellor, Azi, and I like your scheme; but
having got them out, what then?”
He asked this question with a great deal of significance; for although
a diabolical thought was shaping itself in his brain, his recreant heart
dare not give it words. And so he waited for his tool to make the
suggestion.
“Having got them out, I think the rest is easy, your Highness.”
“Well, well,” the other cried, impatiently, as Azimoolah seemed to
dwell too long upon his words.
“We will provide them with carriage down to the river. There we will
have a fleet of large, thatched-roof boats. On board of these boats
the English people, who have given you so much trouble, shall
embark.”
“Well, go on—I follow,” said the Nana, as Azimoolah paused again.
“Having got them on board, what then?”
“We will slaughter them, your Highness—man, woman, and child.
Not one shall live to tell the tale. On each side of the river we will
have heavy guns posted, and our troops shall line the banks. A
mouse would not be able to escape.”
“Good! I leave all to you,” was the Nana’s only answer. But his tone
of voice betrayed the joy he felt.
Azimoolah retired to his tent, and, calling for writing materials and
pen, with his own hand he wrote the following missive in English:—
“To the subjects of Her Majesty Queen Victoria: All those who are in
no way connected with the acts of Lord Dalhousie, and are willing to
lay down their arms, shall receive a safe passage to Allahabad.”
The next morning an armistice was proclaimed, and Azimoolah,
accompanied by two Sepoys, presented himself before the
entrenchments.
This temporary cessation of hostilities was a great relief to the
starving and worn-out garrison. They were prepared to listen to any
terms that did not propose dishonourable surrender. General
Wheeler called up two captains and the postmaster, and gave them
full powers to go out and treat with the emissaries of the Nana.
Azimoolah proposed surrender, without the customary honours of
war. But this the officers would not entertain for a single instant, and
demanded that the British should march out with their arms and sixty
rounds of ammunition in the pouch of every man. The Nana was to
afford them safe escort to the river, provide carriages for the women
and children, and provisions of flour, sheep, and goats for the
voyage to Allahabad.
These proposals were written on a sheet of paper and given to
Azimoolah, who returned to his lines; while the officers went back to
their entrenchments.
As they made known the terms they had submitted, there was
rejoicing in the little garrison. The women cheered up as they
thought that an end was coming to their sufferings and sorrow.
So it was; but a different end to what they contemplated. It had been
an awful time during the siege. Human comprehension can scarcely
realise the full measure of the suffering endured by the devoted
band. It possibly stands without a parallel in the world’s horrors
begotten by war.
For some hours the people waited in anxious suspense; their hearts
beat high, and the wan cheeks flushed as the sounds of a bugle fell
upon their ears.
A horseman had arrived from the rebel camp, and brought word that
the terms had been agreed to, and the garrison was to remove that
night. But General Wheeler flatly refused to do this, saying that he
could not get his people ready until morning.
“Let it be so,” said the Nana, when the message was brought; “we
can afford to give them a few hours.”
In the rebel camp there was great rejoicing; quantities of drink were
consumed; and there was gambling and singing throughout the long
dark hours.
In the entrenchments there was peace; silence reigned, broken
occasionally by the audible prayer from some grateful heart as it
uttered its thanks to the Christian’s God for the relief He had brought
them.
CHAPTER XXIII.
AS WITH AN ENCHANTER’S WAND.
During the terrible night—a night full of hope for the starving,
miserable people in the Cawnpore entrenchments—the little garrison
were busy making preparation for their departure on the morrow.
That is, such preparations as they could make, which, for the most
part, consisted of gathering together the trifling remnants of their
treasures. Here, a treasured portrait was carefully stowed away;
there, a lock of hair cut by loving hands from the head of some dear
one, whose earthly troubles were ended, was wrapped up and
placed between the leaves of a well-worn Bible, so that it might
serve in future time as a sorrowful memento of that awful siege.
Through those dreary hours of darkness there was one who sat
apart from his companions; he was weary and jaded, but sleep
refused to visit him. This was Walter Gordon. As he sat there, with
his head bowed on his hands, it would have been almost impossible
to have detected the European in the guise of the native, for he still
wore the costume in which he had left Meerut. And the disguise was
rendered more perfect by long exposure of the sun, and by smoke
and grime from the powder which seemed to have literally been
burnt into the skin.
An unutterable grief appeared to be pressing him down; for his
thoughts wandered to one whom he dare not hope could be alive
and well. The plan arranged by Zeemit Mehal for Miss Meredith’s
rescue had, so far as he was able to judge, resulted in nothing,
because however successful she might have been, the investing
enemy had prevented any news reaching him from the outside
world; and even if Zeemit had been able to get Flora free from Delhi,
he knew that, without assistance, speedy recapture must result.
During the long weeks that he had been shut up in the
entrenchments, the excitement of the siege had prevented his
thoughts from dwelling too closely upon his troubles. But now that
that excitement was over, and the reaction set in, he felt an anguish
of mind and body that almost threatened to upset his reason. The
promise of the coming release gave him no pleasurable feeling. His
business was ruined; the fate of the woman who was to have been
his wife unknown; nearly all his friends killed; and he, lonely and
broken-hearted, a wreck compared to what he was a few bright
happy weeks ago. As the memory of that night in Meerut, when Flora
Meredith had warned him of the coming danger, rose up before him,
he felt that it would be a relief if any one of the enemy’s shot would
but come and cut his thread of life. He had allowed her warning to
pass unheeded; nay, had absolutely laughed it to scorn, as the
emanation of one who was morbid and out of sorts. He might have
saved her then, have saved his possessions, and all belonging to
him and her. But he remained inactive. He allowed the precious
moments to glide by, until the storm burst in all its fury, and escape
from its consequences was impossible.
He gave up all thoughts of ever seeing his friend Harper again. It
was true that sufficient time had not elapsed for the succour to
arrive, even if he had managed to live through the thousand dangers
he would have to face. But it was such a forlorn hope, that Gordon
felt it was a fallacy to cherish any expectation of again seeing him.
Life, as viewed through the medium which then presented itself,
seemed to have practically ended for him. If he reached Allahabad, it
would be but as a storm-tossed waif, thrown up, as it were, by a
raging sea that had washed away all that was dear and precious,
leaving him lonely and broken-hearted, to curse the unlucky chance
that had saved him.
These were his melancholy reflections. After all he had endured, it
was scarcely matter for wonder that they should be gloomy and
tinged with morbidness.
There are moments sometimes in a person’s existence when life
seems full of nameless horrors—when death is viewed in the light of
a loving friend who brings peace and rest.
Such a moment as this was Walter’s experience. His cup of sorrow
was full; it was overflowing, but then, when the tide has reached its
highest flood, it commences to recede. Night was nearly passed.
The fairy-like glamour which precedes the coming dawn, especially
in India, was over the land. It was like a flush on the face of nature—
surrounding objects were commencing to assert their presence. The
outlines of trees and buildings could be faintly discerned, standing
out against the roseate-flushed sky.
With the departing darkness and coming light, a faint glimmer of
hope appeared upon the path of Walter Gordon; he began to think
that things might not be so bad after all; and then his senses were
suddenly and unexpectedly soothed by the melody of a bird. For
weeks the roar of the guns had scared all the feathered songsters
away; but the cessation of the din for the last twenty-four hours had
induced a stray bul-bul—that gem of the Indian feather tribe—to
alight on the branches of a blackened and shot-shattered tree which
stood some little distance away.
Perhaps the tiny singer had wandered from its tribe, and, missing the
rich foliage which the storm of fire had destroyed over an extensive
area, it was uttering a lament; for there was ruin, desolation, and
decaying mortality around—the work of man’s hand; and the song of
the bird might have been a song of sorrow. Who can tell? But as it
sat there a mere speck on the leafless and blackened tree, and
trilled its beautiful and mellow notes that sounded clear and soft on
the still morning air, the soul of Walter Gordon was touched.
The wand of the enchanter, in the shape of the piping bul-bul, had
changed the scene. From the fierce glare and the strife-torn land of
India, he was suddenly transported to his native shores. He saw the
peaceful valleys of smiling England—he heard the clanking of the
wheels of industry as they brought bread to toiling millions, and sent
forth their produce to all the corners of the earth. He saw the happy
homes where the laughter of merry children made light the hearts of
their parents. He saw that land with all its beauty—a land free from

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With the booming of that gun, as the terrible day dawned on

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