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1. A patient's physician writes a medication order to administer 20 mEq of potassium chloride to
a patient. The ICU nurse misreads the order as 200 mEq of potassium and administers this
amount of medication to the patient. As a result, the patient dies. This situation is an
example of which of the following?
A) A questionable medical order
B) Negligent supervision
C) Ordinary negligence
D) Gross negligence
2. A family member of a patient files a complaint against an ICU nurse, claiming that the nurse
improperly transferred the patient from a wheelchair to the hospital bed, resulting in a back
injury to the patient. Assuming that the nurse's due process rights are observed, which of
the following actions would be most advisable for the nurse?
A) Plan to appeal to a court if the State Board of Nursing rules against her.
B) Sue the State Board of Nursing if her license is suspended before she is found guilty.
C) Acquire legal counsel and have him or her question the board's witnesses.
D) Continue nursing practice if her license is suspended, as such a suspension violates her
constitutional rights.
3. The ex-husband of a patient asks the ICU nurse a question about the medical history of the
patient. The nurse retrieves the patient's file, opens it, and relates some of the patient's
personal information to the ex-husband. When the ex-husband asks to see the patient's file,
the nurse hands it to him, although he is not authorized by the patient to see this
information. What is the most accurate characterization of the nurse's action?
A) A criminal act against the patient
B) A breaking of the rule of personal liability
C) A violation of the HIPAA Privacy Rule
D) A case of respondeat superior
5. A jury involved in a malpractice suit must decide how much to compensate a patient for the
emotional distress caused her by incomplete anesthesia during surgery. To which element
of malpractice is this decision related?
A) Duty
B) Breach of duty
C) Causation
D) Damages
6. A nurse is going to volunteer her nursing skills and time at a hospital other than the one in
which she is employed. Which of the following is true regarding potential liability related to
the nurse's actions while volunteering? Select all that apply.
A) The nurse should carry her own malpractice insurance.
B) The hospital at which she is volunteering will protect her with its own professional liability
insurance.
C) The hospital at which she is employed will protect her with its professional liability
insurance even when she is working off the job.
D) There is no liability protection available for a nurse who is volunteering on her own time.
E) The doctrine of respondeat superior does not apply in this situation.
F) The captain of the ship doctrine applies in this situation.
7. A nurse is charged with medical malpractice because she neglected to attend to a patient in
the ICU whose heart stopped and whose heart monitor alarm was clearly heard by the
nurse. The jury finds that the hospital was liable because of understaffing the ICU and that
the nurse was liable because she should have responded to the patient whose heart stopped,
regardless of the fact that she had been ordered by a physician to tend to another patient.
Which types of liability did the jury uphold? Select all that apply.
A) Captain of the ship doctrine
B) Rule of personal liability
C) Corporate liability
D) Criminal liability
8. A physician has written a medication order for a patient that includes penicillin. When the
nurse receives the order, she refuses to administer the medicine because she knows that the
patient is allergic to it. What is the most accurate way to describe this situation?
A) A questionable medication order
B) A medication error
C) A case of respondeat superior
D) A case of negligent supervision
9. A patient in the ICU dies as a result of a defective defibrillator. The nurse did not become
aware of the defect until after the patient's death. Which of the following is true in this
situation?
A) Defibrillators are not currently regulated in the United States.
B) The nurse is permitted but not required to report the malfunction to the FDA.
C) The nurse is required to report the malfunction to the FDA.
D) The nurse is likely liable in the patient's death.
10. A 10-year-old girl has been admitted to the ICU after she suffered a severe laceration on her
arm. Due to heavy hemorrhaging, the child needs a blood transfusion. Her parents,
however, who are Jehovah's Witnesses, do not believe in blood transfusions and refuse the
treatment. What would be the best action for the nurse to take?
A) Assist the physician in performing a blood transfusion for the girl, against her parents'
wishes.
B) Refuse to assist the physician in performing a blood transfusion, to respect the parents'
wishes.
C) Consult the hospital's risk management department before acting.
D) Schedule a conference with the parents to explain why an infusion is medically necessary.
11. While caring for patients, the nurse completely documents the care given. This nursing
action is defined by what kind of law?
A) Administrative
B) Civil
C) Tort
D) Criminal
12. Nursing practice is defined by the Nursing Practice Act, administered by the State Board of
Nursing. Which nursing behavior would be least likely to be addressed by the State Board
of Nursing?
A) Qualifications for licensure
B) Investigation of complaints
C) Nursing excellence awards
D) Protection of patient safety
13. The physician has ordered a medication that is contraindicated for the patient. The nurse,
after discussion with the physician and the pharmacy, refuses to administer the medication.
Upon what legal principle does the nurse base this refusal?
A) Respondeat superior
B) Captain of the ship
C) Corporate liability
D) Rule of personal liability
14. The nurse caring for a sedated patient leaves the side rails down when leaving the room and
the patient falls, breaking her hip. Why is this considered to be malpractice by negligence?
A) The patient had requested the side rails be left down.
B) The nurse assumed that the family would watch the patient.
C) This is breach of duty resulting in patient harm.
D) There will probably be a suit brought by the family.
15. A nurse has been called before the State Board of Nursing for accusations of malpractice. As
part of his defense, the nurse states that he was unaware of several provisions of the
Nursing Practice Act. Why is this defense statement valid or invalid?
A) Invalid: The nurse has a legal duty to know the contents of the Nursing Practice Act.
B) Invalid: Nursing Practice Acts vary widely in content from version to version and state to
state.
C) Valid: The nurse did not know he was violating the Nursing Practice Act at the time of his
actions.
D) Valid: The nurse was under the supervision of his charge nurse at the time of his actions
16. The nurse is caring for a critically ill patient. Which action by the nurse could most likely be
considered malpractice?
A) Assessing for allergies before administering medications
B) Consistent failure to complete adequate hand hygiene
C) Strict adherence to the visiting hours policies of the unit
D) Encouraging the patient to ask questions of the physician
17. The nurse has been accused of negligence resulting in patient harm. She was not informed
about the complaint, and her employment was terminated before a hearing before the State
Board of Nursing. What best legal recourse does the nurse have?
A) Safe harbor provision in state law
B) Fifth Amendment of the U.S. Constitution
C) Civil and tort law allows the nurse to sue the accuser.
D) Automatic dismissal of case by the State Board of Nursing
18. A nurse who commonly works on a general medical-surgical floor is asked to work briefly
in a critical care unit. The charge nurse, based on the legal principle of vicarious liability,
should give this nurse which patient assignment?
A) Admit day-of-surgery patient after open heart surgery
B) Three stable patients awaiting transfer to medical units
C) Patient with hemodynamic monitoring and unstable vital signs
D) Patient whose care requires frequent titration of vasoactive medications
19. After receiving an injury as a result of negligent care by a physician, the patient brings suit
against the hospital, the physician, and all of the members of the health care team who
participated in his care. Based on the principle of respondeat superior, the hospital is liable
for the actions of whom?
A) Nurse working in her usual assignment at hospital
B) Non-employee physician practicing in the hospital
C) Nurse on temporary assignment from an agency
D) Nurse doing volunteer work at another agency
20. A patient in CCU is critically and terminally ill. The family has made a written request that
no cardiopulmonary resuscitation (CPR) take place. The patient is well known to the
physician, who does not agree with the family's assessment of the situation. While the
physician is discussing the situation with the family and before agreement, the patient
experiences a cardiopulmonary arrest. Legally, what is the most appropriate nursing action?
A) Proceed as though a DNR order has been written, since such an order is anticipated.
B) Take no action and page the patient's physician to ask for an immediate decision over the
telephone.
C) Initiate CPR and page the patient's physician to come to the care unit.
D) Take no action and page the patient's family to return to the care unit immediately.
21. A patient has been critically ill for several weeks and a Do Not Resuscitate (DNR) order was
written several days ago. The patient's status has improved, and he is now eligible for
transfer to a general nursing unit and is awake and alert. What is the most appropriate
nursing action?
A) Initiate risk-reduction teaching to prevent recurrence of instability.
B) Ask the patient, family, and physician to review the DNR order.
C) Increase the frequency of monitoring of vital signs to ensure safety.
D) Encourage the patient to get more rest in preparation for transfer.
22. A terminally ill patient is admitted to the CCU for stabilization and palliative procedures.
The nurse encourages this awake and alert patient to complete paperwork for advance
directives. What is the best rationale for this nursing action?
A) Required by the admission protocol for the hospital and the unit
B) Allows the patient to express his or her choices for some treatment decisions
C) Prevents estranged family from interfering with competent patient decisions
D) Allows the physician to apply his or her best judgment for care decisions
23. A critical care nurse has administered an intravenous sedative in an excessive dose to a
patient. The patient experiences a cardiopulmonary arrest, and the family complains to the
State Board of Nursing. After investigation and a hearing, the Board finds that the nurse
was guilty of malpractice and disciplines the nurse. This situation is an example of what?
A) Medication errors are the most common reason for State Board of Nursing action.
B) An unusual and rare incidence of lack of judgment by a nurse in a stressful situation
C) Absence of the application of due process for the nurse by the State Board of Nursing
D) A family looking for an opportunity for litigation
If there were not so much to tell before I lay down my pen, I might
describe the feast which Te Makawawa and his chiefs prepared for
us that evening, or give the substance of the wild, poetical songs that
were sung in our honour, and of the speeches that were delivered—
all bristling with allusions to ancient tradition. But the matter, though
interesting, does not concern this history directly. Suffice it to say,
then, that I had, from the first, developed a slightly sceptical attitude
towards the old chief’s story. This was accentuated by the fact that,
after the feast of which I have spoken, one of the songs sung by a
young chief contained a chance allusion to Hinauri, giving in a few
words the skeleton of a popular legend which differed almost entirely
from Te Makawawa’s tradition of the same person. Even if this
discrepancy could be explained by saying that a popular legend is
often fabricated around the central name of some more ancient
tradition, it still remained to deal with the extraordinary parts of Te
Makawawa’s story, which were not easy of belief without some kind
of verification. Therefore I had many a grave doubt.
On the following day, when we took our departure, the aged chief
sent with us a Maori named Tiki, who had been with the party which
had taken the child, fifteen years before, and left her at the hut of the
Man-who-had-forgotten. This Maori was to be my servant, to aid me
in finding Keritahi Kerei, or, as we should pronounce it, Crystal Grey.
He was to obey me in all things, and not to leave me under any
conditions until the child—now, of course, if living, a girl seventeen or
eighteen years of age—was found and brought to Te Makawawa.
When we three, Kahikatea, Tiki, and myself, were leaving the pa,
the old chief gave us a solemn and sad farewell. Sitting at the
doorway of his house, he said: “Depart, O Kahikatea, Dreamer of
dreams! Take not again the ‘way of the spider’ lest you become even
as he who has forgotten his name and the face of his friend. Depart,
O seeker of the child whose mother awaits you, and forget not my
words. Go, my friends, to whom I have shown the secret of the ages.
Go! while I remain here watching the kohutukutu’s yellow leaf that
will not fall, watching the western sun that cannot set.”
So we left the pa of Te Makawawa, our hearts full of the strange
tale we had heard. When we reached the bank of the river we sat
down on a log and looked at one another.
“Do you believe the old chief’s tale?” I asked Kahikatea.
“It accounted for my dream,” he replied; “but, do you know, I have
never been able to decide whether I dreamed that about the stone
woman in the cave, or whether it was an actual experience I went
through. All I can be certain of is, that on the floor of my hut, two
years ago, I awoke from what I took to be a kind of syncope due to
failure of the heart’s action. I went out and shook myself together,
and recalled a hazy memory of those things I related to the old chief.
Of course, I dismissed the matter as a dream, though that pure white
woman’s face I could not, cannot, and do not wish to, dismiss, for I
admit to you candidly that I would risk my life to see it again: it has a
fine meaning. I say I explained it as a dream, but what perplexed me
some time later was, that in my record of the month from full moon to
full moon I discovered a gap of three days. Then another thing which
puzzled me was that I had a great many bruises that I could not
account for, one in particular: a painful sore on my back—by Jove!”
He started up in an excited manner and threw off his coat. Then in
another moment his shirt followed, and he stood stripped to the
waist.
“Look!” he cried, turning his back to me; “just between the
shoulder blades—is there any kind of mark?”
It was my turn to express surprise now, for there, in the spot he
had indicated, was a peculiar tatooed sign—a square in a circle, with
a small cross in the centre.
I described it to him, and when I had finished he turned round and
faced me.
“The sign of forgetting,” he said.
“The ‘sign of forgetting,’ ” I repeated, and my scepticism suffered a
shock.
“I thought,” he mused slowly, as he proceeded to dress himself
again, “I thought I could not have spent three whole days in that
syncope. If I went to that mountain temple and was branded with this
mark, which made my adventure seem like a dream, why should not
they have branded Grey in such a way—say by rubbing in a different
drug—as to make him forget his own name and the face of his
friend?”
“And yet—and yet—” I said with some hesitation, “the whole of Te
Makawawa’s tale is so remarkable that I cannot say I feel justified in
setting out to look for that child without some more certain proof. It is
quite possible the old chief has invented the story of the child so as
to get us out of the way. The search may lead me to the other side of
the world, whereas the Table Land and the mountain are not three
days’ journey from here. I believe most firmly that Miriam Grey is
there if she is living, but I’m inclined to think that, if there was a child,
it died, or was drowned, and that old Te Makawawa invented the rest
of the story to throw us off the track. What do you think? Is not our
best plan to go and spy out the mountain first?”
“It may be so,” he replied meditatively. “Personally my interest is
neither in the child nor in the woman, but in the existence of that
ancient temple of a forgotten race, with its white goddess who rivals
the dawn, gazing out into the sky with a prayer on her face, and her
arms held up to the daybreak of the golden age. It is a grand symbol
and, as I said before, I would risk my life to verify it; for even the face
of that marble woman appeals to me as no woman’s face has ever
done before. I see it in my mind, not as stone, but as that of a living
woman whose eyes are full of a holy light. I will go with you to the
mountain wall, and, notwithstanding the old chief’s warning, I will
search for the ‘way of the spider.’ ”
“Agreed,” I said, “and I will look for the ‘way of the fish,’ whatever
that may be, and take my chance of the fierce Ngaraki.”
With our minds made up we decided that it would be better not to
inform Tiki of our purpose until, in our route southwards, we came to
a point where we could branch off towards the Table Land. We took
this precaution lest he should find an opportunity of hurrying back in
the night or sending a chance messenger to Te Makawawa telling
him of our purpose, in which case I felt convinced we should be
followed by a band of his warriors. Having questioned Tiki, I found
that the way by which I was to seek the child lay through Karamea,
to the west of the Great Tapu Land. It would be an easy matter then
to change our minds on the journey, and direct our course towards
the forbidden region which we knew must be the place we wanted.
Of our progress on foot towards Karamea little need be said,
except that it was fraught with all the difficulties of the virgin bush.
Kahikatea had a fowling-piece, and I had my rifle, so that we had no
difficulty in procuring wild duck, with here a pig and there a pukako
or a kakariki. We gathered our larder up as we went along, for we
found the bush-clad hills and gullies most plentifully stocked.
On the evening of the third day we saw a high range of snow-
capped mountains far away on our left, and questioned Tiki about
them.
“That is the Great Tapu Land,” he said, lowering his voice.
After a conversation over the camp fire in our own tongue, we
decided that the time had come to change our course. Accordingly,
in the morning we informed the Maori that the curiosity of the white
man was great: we wished to see this forbidden country. He looked
scared at this; but, when we told him he must accompany us, his
legs trembled under him, and I verily believe that if they had been
any use to him at the moment, he would have fled for his life.
“Taniwha lives there,” he said, “it is tapu. The Maori must not go
there; it is the place of evil spirits.”
“Why is it tapu?” I asked.
He shook his head. “When the ariki make a place tapu it is
because it is dangerous to go there.”
I was determined to see how much he knew, so I continued to
question him.
“How long has it been tapu?” I asked.
“From the times of Wiwa and Wawa, when men had wings,” he
replied. “Do not venture on it, O Pakehas. The ariki who have been
there to appease the evil spirits have come back and told us of the
terrible monsters that inhabit the land, and of the evil spirits that are
on the watch for anyone who sets foot there.”
“What kind of spirits are they?”
“Listen, O Rangatira! Some men of Ngatimamoe once lost their
way and crossed the high level land beneath those peaks, when they
came to a great wall of rock, out of which a stream ran forth into a
deep pool. Here they stood and watched the bubbles coming up,
when they saw something rising out of the depths. It came to the
surface and spouted the water from its mouth. Then they fled, for
they knew that only taniwha rise out of the depths in that way. It was
the evil spirit of the mountain, and they who had seen it were
doomed.”
“What happened to them?” I asked.
“They all died before another moon had passed,” he replied
triumphantly.
“And are you afraid because of a silly story like that?” I said, well
knowing the superstitious dread the Maori has of the demon taniwha,
even if it only comes in the shape of a small green lizard. But he was
not to be shaken in his belief.
“Ah,” he replied gravely. “I have heard that the Pakeha is afraid of
nothing, because he believes in nothing. But the Maori knows these
things are true: the whole place is bewitched with devils, Pakeha; do
not go near it.”
Kahikatea, who had been sitting on a log cutting tobacco with his
bush knife, now restored the weapon to its sheath on his hip, and
remarked, as he charged his pipe: “The fact of this tremendous tapu
being laid on the whole place shows very clearly that there is a
secret to be kept by those mountains—a secret known only to the
tohungas who imposed the tapu. And these wild tales I imagine to be
a piece of priestcraft to add additional protection to the secret.”
Then, rising and standing over the Maori, he went on in his forcible
way: “Look here, Tiki! We’re going, and you’ll have to come with us.
Te Makawawa, the ariki, has been many a time to this Great Tapu to
appease the taniwha; remember that. And his words to you were,
‘Do not leave the Pakeha Wanaki until the child is found.’ Now, if you
run away in the night while we sleep, I shall tell Te Makawawa, and
he will turn the whole brood of taniwha loose on you, and they will
tear you to pieces, so that the name of Tiki will be forgotten in the
land.”
This idea was too much for the Maori, and he gave in.
“O Kahikatea,” he said, “I will go with you, but remember my word:
he who goes into the Great Tapu returns not—all that returns is a cry
from the dark.”
So the matter ended, and, after a substantial breakfast, we
started, heading towards the east, where the peaks of the great
mountain chain showed against the sky. But it was like dragging a
load of stones, getting Tiki along against that heavy tapu. Whenever
he could get me alone he improved the opportunity by telling me
some of his terrible tales of taniwha, in the hope of getting me to
prevail upon Kahikatea to turn back from the haunted mountain. But,
interesting as his tales were, he only succeeded in making his own
hair stand on end, for though I may be a lover of Maori lore, I cannot
lay claim to an overwhelming fear of the taniwha.
But we found there was some foundation for Tiki’s spouting
monster. It happened in this way. In the afternoon we travelled along
the bank of a mountain stream, that ran down from the Great Tapu
beyond. It was a small body of water in a deep rocky bed. We
followed it up for several hours, and by sunset reached what we took
to be its source—a deep pool, some twenty yards across, at the foot
of a tremendous rocky cliff, on the face of which grew rare ferns, with
here and there the crimson or white rata vine. The quiet overflow of
this pool swept down beneath high banks, whose flowers and ferns
were now flushed and glistening in the sun, which sent a few
struggling rays between the black trunks of some mountain birches.
It was a pleasant spot, with a broad green bank on the one hand,
where the afternoon sun had found an entrance, while, on the other,
where the sunlight never reached, a perfect grotto of rare ferns grew
from the crevices of the rocks that composed the high overhanging
bank.
Here upon the broad green sward we built our camp fire and
prepared to stay the night, and it was here that the strange thing
happened which went a long way to confirm Tiki in his ideas of the
haunted mountain and perplexed us not a little. Twilight was
deepening over the gloomy hills, and the silence in which bush
travellers hear mysterious noises grew deeper and deeper as the
late-singing birds stopped their songs one by one to make way for
the little owls. We sat upon the bank of the pool, smoking after our
meal and looking idly at the water, when the Maori’s quick ear caught
some unusual sound. He sprang up and stood stock still, with a
scared look upon his face.
“Is it a taniwha coming, Tiki?” I asked, for I could hear nothing.
Presently, however, a distant moaning sound seemed to come out
of the ground.
“The earth is shivering,” said Kahikatea, rising from his sitting
posture.
“It is nothing, Tiki,” I cried; “it’s only Ru, your restless earthquake-
god, turning in his rocky bed. He is rearranging his mat and his
pillow; he’ll soon settle down again.”
But the sound grew nearer and louder, and the bank on which we
stood trembled visibly. Then there was a hollow roar underground,
and Tiki, without waiting to see what came of it, shrieked “Taniwha!”
and turned to fly.
But Kahikatea was too quick for him. His long arm swept out and
caught the Maori by the shoulder. Then, as he wheeled him round
and nailed him to the spot, a great torrent of water burst forth out of
the pool, and rose to a height of ten or fifteen feet in the air, swelling
the stream level with its banks as it swept away. The noise of this
rushing fountain, as it rose and fell into the pool, drowned all speech,
and for some minutes we stood looking at it, too surprised to speak. I
heard a howl of fear from Tiki, as my friend, gripping him by both
arms from behind, made him face it.
“It’s an intermittent spring,” roared Kahikatea presently, above the
tumult.
We watched the column of water springing now several feet
higher, and then sinking lower as its force increased and abated
alternately, and shouted many conjectures between the howls of Tiki.
The seething pool dashed spray in our faces, and we drew back.
In ten minutes or a quarter of an hour a sudden change came over
the springing column of water. It sank gradually back into the pool.
The tumult ceased, and the water fell to its former level. The small
stream then flowed quietly through the bed of its channel, and all
was still again.
Tiki was the first to break the silence.
“The evil spirits have let the flood loose,” he cried. “Did I not say
the place was tapu? O Wanaki, let us go back.”
A profuse perspiration was on the Maori’s forehead, and his knees
shook. I felt sorry for him, and proceeded to explain an elaborate
theory of intermittent springs, helped here and there by a word from
Kahikatea. At length we took the keen edge off his fear, for he
admitted that our mana15 was great, but he would not accept our
explanation. Taniwhas were more in his line, and his attitude seemed
to be based on this principle: Why invent an elaborate hypothesis
like ours when a simple one like his would account for all the facts?
Some little time later, when our astonishment had worn off a little,
and Kahikatea had begun to gather ferns on the other side of the
pool, Tiki took advantage of the opportunity to urge me even more
strongly to turn back and not venture further into the haunted place.
But I assured him that we had no intention of taking his advice, and
he accepted the inevitable, saying again that our mana was great,
and that when we got out of the tapu we would no doubt reward his
bravery by giving him a pair of trousers and a new pipe—indeed, in
consideration of value received, he seemed almost willing to
renounce his religion altogether. By his reassuring remarks I
certainly gathered the impression that if he were only clad in a
complete suit of European clothes no taniwha could touch him. He
was no high-class Maori to talk like that, for, if Te Makawawa had
caught him in trousers, he would have ordered them off, and
thrashed him within an inch of his life for forsaking the ancient glory
of his race.
Nothing remarkable happened during the remainder of that night,
unless it was that Kahikatea moaned in his sleep several times, and I
caught the impassioned words, “Hinauri! Hinauri!” A strong feeling of
friendship had sprung up within my heart for this strange man, with
his passionate love of birds and trees, of snow-capped mountains
and deep, wide solitudes; of great symbols and lofty ideals. His very
stone goddess, set with fantastic meaning in the high solitudes of the
everlasting mountains, appealed to me as the strongest part of the
bond that already existed between us. I lay wondering who he was,
and what his past life had been; and, as I wondered, I fell asleep.