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Clinical Nursing Skills and Techniques

8th Edition Perry Test Bank


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Chapter 10: Exercise and Ambulation

MULTIPLE CHOICE

1. The patient has been admitted for hypertension. His blood pressure is normally in the 160/90
range. He has been on bed rest for the past few days, and the doctor has started him on a new
blood pressure medication. The nurse is assisting the patient to move from the bed to the chair
for breakfast, but when the patient tries to sit up on the side of the bed, he complains of being
dizzy and nauseous. The nurse lays the patient down and takes his vital signs. His pulse is
124. His blood pressure is 130/80. This blood pressure is indicative of what?
a. A normal blood pressure for this patient
b. Orthostatic hypotension
c. Orthostatic hypertension
d. Effective baroreceptor function
ANS: B
Orthostatic hypotension is a drop in blood pressure that occurs when the patient changes from
a horizontal to a vertical position. It traditionally is defined as a drop in systolic or diastolic
blood pressure of 20 or 10 mm Hg, respectively. Those at higher risk are immobilized
patients, those undergoing prolonged bed rest, the older adult patient, those receiving
antihypertensive medications, and those with chronic illness, such as diabetes mellitus or
cardiovascular disease. Signs and symptoms of orthostatic hypotension include dizziness,
light-headedness, nausea, tachycardia, pallor, and even fainting. Orthostatic hypertension
would be an increase in blood pressure. Physiological changes associated with aging and
prolonged bed rest may reduce the effectiveness of the baroreceptors. In these patients,
moving to the dangling position may cause a gravity-induced drop in blood pressure; thus, it
is recommended to raise the head of the bed and allow a few minutes before dangling.

DIF: Cognitive Level: Analysis REF: Text reference: p. 236


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Orthostatic Hypotension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The patient is an elderly gentleman who has been on bed rest for the past several days. When
getting the patient up, the nurse should:
a. tell the patient not to move his legs when dangling.
b. tell the patient to hold his breath while dangling.
c. raise the head of the bed and allow a few minutes before dangling.
d. have the patient stand without dangling.
ANS: C
Physiological changes associated with aging and prolonged bed rest may influence the
effectiveness of the baroreceptors. For these patients, moving to the dangling position may
cause a gravity-induced drop in blood pressure; thus, it is recommended to raise the head of
the bed and allow a few minutes before dangling. Interventions to minimize orthostatic
hypotension include movement of the legs and feet in the dangling position to promote venous
return via intermittent contraction and relaxation of the skeletal leg muscles, and asking the
patient to take several deep breaths before and during dangling. Dangling a patient before
standing is an intermediate step that allows assessment of the individual before changing
positions to maintain safety and prevent injury to the patient.
DIF: Cognitive Level: Application REF: Text reference: p. 236
OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Dangling KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. An appropriate technique for the nurse to use when performing range of motion (ROM)
exercises is to:
a. repeat each action five times during the exercise.
b. perform the exercises quickly and firmly.
c. support the proximal portion of the extremity being exercised.
d. continue the exercise slightly beyond the point of resistance.
ANS: A
Each movement should be repeated five times during an exercise period. Be sure that ROM
exercises are performed slowly and gently. When performing active-assisted or passive ROM
exercises, support the joint by holding the distal portion of the extremity, or by using a cupped
hand to support the joint. Discontinue exercise if the patient complains of discomfort, or if
you note resistance or muscle spasm.

DIF: Cognitive Level: Application REF: Text reference: p. 223


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. A patient is admitted to the medical unit following a cerebrovascular accident (CVA).


Evidence of left-sided hemiparesis is noted, and the nurse will be following up on ROM and
other exercises performed in physical therapy. The nurse should correctly teach the patient
and family members which of the following principles of ROM exercises?
a. Flex the joint to the point of discomfort.
b. Medicate the patient after the ROM exercise session.
c. Move the joints quickly.
d. Provide support for distal joints.
ANS: D
When performing active-assisted or passive ROM exercises, support the joint by holding the
distal portion of the extremity, or by using a cupped hand to support the joint. The joint should
be flexed to the point of resistance, not to the point of discomfort. Assess the patient’s level of
comfort (on a scale of 0 to 10, with 10 being the worst pain) before performing exercises.
Before beginning ROM exercises, determine whether the patient would benefit from pain
medication. Joints should be moved slowly through the ROM. Quick movement could cause
injury.

DIF: Cognitive Level: Application REF: Text reference: p. 222


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. A nurse should be concerned when observing a patient performing isometric exercises if the
patient is:
a. holding his or her breath while exerting.
b. performing the exercises four times per day.
c. tightening each muscle group for 8 seconds, then relaxing.
d. repeating each exercise 8 to 10 times for each muscle group.
ANS: A
Patients doing isometric exercises should be taught to exhale while exerting effort. Many
persons hold their breath (Valsalva maneuver), which increases intrathoracic pressure, causing
a decrease in venous return to the heart. Each exercise prescription is individualized according
to the patient’s needs and limitations. Gradual buildup of exercise repetitions improves both
muscle strength and endurance. Hold the muscles tightly contracted for 5 to 15 seconds, and
then relax completely for several seconds.

DIF: Cognitive Level: Application REF: Text reference: p. 228


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Exercises KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

6. A nurse encourages a patient to prevent venous stasis by:


a. crossing the legs when sitting in a chair.
b. wearing thigh-length nylon stockings or garters.
c. elevating the legs on pillows while in bed.
d. increasing early ambulation.
ANS: D
Prevention is the best method to reduce the risk for deep vein thrombosis (DVT) secondary to
immobility. Early ambulation remains the most effective preventive measure. Discourage
patients from activities that promote venous stasis (e.g., crossing legs, wearing garters,
elevating legs on pillows).

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Venous Stasis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

7. Antiembolic stockings (TEDs) are ordered for the patient on bed rest after surgery. The nurse
explains to the patient that the primary purpose for the elastic stockings is to:
a. keep the skin warm and dry.
b. prevent abnormal joint flexion.
c. apply external pressure.
d. prevent bleeding.
ANS: C
The primary purpose of TEDs is to maintain external pressure on the muscles of the lower
extremities and thus promote venous return. The primary purpose of TEDs is not to keep the
skin warm and dry, prevent abnormal joint flexion, or prevent bleeding. They are used to
prevent clot formation due to venous stasis.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Antiembolic Stockings KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

8. When assessing the patient for risk for DVT, the nurse should consider which of the following
an indicator of increased risk?
a. A positive Homans’ sign
b. Pallor to the distal area
c. Edema noted in the extremity
d. Fever or dehydration
ANS: D
Indicators in Virchow’s triad include clotting disorders, fever, and dehydration. Additionally,
a swollen extremity, pain, and warm cyanotic skin, indicate an elevated risk. Less than 20% of
patients exhibit a positive Homans’ sign. Edema of the extremity may or may not occur.

DIF: Cognitive Level: Application REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: DVT KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

9. An appropriate procedure for the nurse to use when applying an elastic stocking is to:
a. remove the stockings every 24 hours.
b. keep the tops of the stockings rolled down slightly.
c. turn the stocking inside out to apply from the toes up.
d. wash stockings daily and dry in a dryer.
ANS: C
Turn elastic stocking inside out by placing one hand into the sock, holding the toe of the sock
with the other hand, and pulling. This allows easier application of the stocking. Elastic
stockings should be removed and reapplied at least twice a day. Instruct the patient not to roll
the socks partially down. Rolling the socks partially down has a constricting effect and can
impede venous return. Instruct the patient to launder elastic stockings every 2 days with mild
detergent and lay flat to dry.

DIF: Cognitive Level: Application REF: Text reference: pp. 234-235


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Applying Elastic Stockings KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
10. When using an SCD, the nurse should:
a. apply powder to the patient’s skin if redness and itching are present.
b. leave a two-finger space between the patient’s leg and the compression stocking.
c. keep the patient connected to the compression device when transferring into and
out of bed.
d. remove the elastic stockings before putting on the sequential pneumatic
compression stockings.
ANS: B
Check the fit of SCD sleeves by placing two fingers between the patient’s leg and the sleeve.
Observe for signs, symptoms, and conditions that might contraindicate the use of elastic
stockings or SCD: Elastic stockings and SCD sleeves may aggravate a skin condition or cause
it to spread. Remove SCD sleeves when transferring the patient into and out of bed to prevent
injury. If the patient is wearing elastic stockings, eliminate any wrinkles and folds before
applying SCD sleeves. Wrinkles lead to increased pressure and alter circulation.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 235


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Applying SCD Sleeves KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

11. The patient is a paraplegic who possesses good arm and hand strength. When the following
devices are compared, which would be most appropriate for this patient?
a. Axillary crutch
b. Platform crutch
c. Lofstrand crutch
d. Standard crook cane
ANS: C
The Lofstrand crutch has a handgrip and a metal band that fits around the patient’s forearm.
Both the metal band and the handgrip are adjusted to fit the patient’s height. This type of
crutch is useful for patients with a permanent disability such as paraplegia. The axillary crutch
frequently is used by patients of all ages on a short-term basis. The platform crutch is used by
patients who are unable to bear weight on their wrists. It has a horizontal trough on which
patients can rest their forearms and wrists and a vertical handle for the patient to grip. The
standard crook cane provides the least support and is used by patients who require only
minimal assistance to walk.

DIF: Cognitive Level: Analysis REF: Text reference: p. 237


OBJ: Develop teaching plans for selected patients for safety precautions to use at home while using
an ambulation aid, applying and monitoring effects of elastic stockings and SCDs, using the CPM, and
performing ROM and isometric exercises. TOP: Crutches
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. An appropriate way for the nurse to measure a patient for crutches is to:
a. have a flexion of 45 degrees at both of the patient’s elbows.
b. have a space of two to three fingers between the top of the crutch and the axilla.
c. place the crutch tips 1 foot to each side of the patient’s feet, and observe the
positioning of the crutches.
d. place the crutch tips 1 foot to the front of the patient’s feet, and observe the
positioning of the crutches.
ANS: B
Following correct crutch adjustment, two to three fingers should fit between the top of the
crutch and the axilla. Following correct crutch adjustment, elbows should be flexed 15 to 30
degrees. Elbow flexion is verified with a goniometer. Position the crutches with the crutch tips
at 6 inches (15 cm) to the side and 6 inches in front of the patient’s feet, and the crutch pads 2
inches (5 cm) below the axilla.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 239-240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutches KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

13. The patient has been using crutches for the past 2 weeks. When she comes for her follow-up
examination, she complains of tingling and numbness in her hands and upper torso. Possible
causes of these symptoms are:
a. the patient’s elbows are flexed 15 to 30 degrees when using the crutches.
b. crutch pad is approximately 2 inches below the patient’s axilla.
c. patient holds the cane 4 to 6 inches to the side of her foot.
d. handgrip does not allow for elbow flexion.
ANS: D
Instruct the patient to report any tingling or numbness in the upper torso, which may mean
that the crutches are being used incorrectly, or that they are the wrong size. If the handgrip is
too low, radial nerve damage can occur even if overall crutch length is correct, because the
extra length between the handgrip and the axillary bar can force the bar up into the axilla as
the patient stretches down to reach the handgrip. After correct crutch adjustment, two to three
fingers must fit between the top of the crutch and the axilla. Adequate space prevents crutch
palsy. Proper fit is when the crutch pad is approximately 2 inches or two to three finger widths
under the axilla, with the crutch tips positioned 6 inches (15 cm) lateral to the patient’s heel.

DIF: Cognitive Level: Analysis REF: Text reference: p. 239


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutches KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

14. The patient has a leg injury and is being fitted for a cane. The patient should be taught to:
a. hold the cane on the uninvolved side.
b. hold the cane on the weaker side.
c. extend the cane 15 inches from the foot when used.
d. maintain approximately 60 degrees of elbow flexion.
ANS: A
The patient holds the cane on the uninvolved side, 4 to 6 inches (10 to 15 cm) to the side of
the foot. This offers the most support when the cane is placed on the stronger side of the body.
The cane and the weaker leg work together with each step. The cane extends from the greater
trochanter to the floor while the cane is held 6 inches (15 cm) from the foot. Allow
approximately 15 to 30 degrees of elbow flexion. As weight is taken on by the hand and the
affected leg is lifted off the floor, complete extension of the elbow is necessary.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 245


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Cane Measurement KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

15. While ambulating, the patient becomes light-headed and starts to fall. What should the nurse
do first?
a. Call for help.
b. Try to reach for a chair.
c. Ease the patient down to the floor.
d. Push the patient back toward the bed.
ANS: C
If the patient begins to fall, gently ease the patient to the floor by holding firmly onto the gait
belt; stand with the feet apart to provide a broad base of support, extend the leg, and let the
patient gently slide to the floor. As the patient slides, the nurse bends the knees to lower the
body. The nurse can cause more damage to self and patient by trying to catch the patient.
The nurse certainly will call for help, but this is not the first priority. The nurse must ensure
the patient’s safety before getting help by easing him to the floor.

DIF: Cognitive Level: Application REF: Text reference: p. 240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Patient Safety KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

16. When the four gaits listed below are compared, which is the most stable of the crutch gaits?
a. Four-point gait
b. Three-point gait
c. Two-point gait
d. Swing-to gait
ANS: A
Four-point gait is the most stable of crutch gaits because it provides at least three points of
support at all times. The patient must be able to bear weight on both legs. Each leg is moved
alternately with each opposing crutch, so that three points of support are on the floor all the
time. This gait is often used when the patient has some form of paralysis, such as for spastic
children with cerebral palsy. This is less stable than four-point gait because it requires the
patient to bear all weight on one foot. Weight is borne on the uninvolved leg and then on both
crutches. The affected leg does not touch the ground during the early phase of three-point gait.
This gait may be useful for patients with a broken leg or a sprained ankle. This is less stable
than four-point gait because it requires at least partial weight bearing on each foot. It is faster
than four-point gait and requires better balance because only two points support the body at
any one time. This is the easier of the two swinging gaits. It is less stable than four-point gait
because it requires the ability to partially bear body weight on both legs. This gait is
frequently used by patients whose lower extremities are paralyzed, or who wear
weight-supporting braces on their legs.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 241-242


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

17. The nurse is caring for a patient who has just been treated for a broken leg. She needs to teach
the patient how to use crutches. Which crutch gait is most appropriate for this patient?
a. Four-point gait
b. Three-point gait
c. Two-point gait
d. Swing-to gait
ANS: B
The three-point gait requires the patient to bear all weight on one foot. Weight is borne on the
uninvolved leg and then on both crutches. The affected leg does not touch the ground during
the early phase of three-point gait. It is useful for patients with a broken leg or a sprained
ankle. The four-point gait is the most stable of crutch gaits because it provides at least three
points of support at all times. The patient must be able to bear weight on both legs. Each leg is
moved alternately with each opposing crutch, so that three points of support are on the floor
all the time. The two-point is used when the patient has some form of paralysis, such as for
spastic children with cerebral palsy. This gait requires at least partial weight bearing on each
foot. It requires better balance because only two points support the body at one time. This is
the easier of the two swinging gaits. It requires the ability to partially bear body weight on
both legs. The swing-to gait is used by patients whose lower extremities are paralyzed, or who
wear weight-supporting braces on their legs.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 241-242


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
18. When teaching the use of a three-point crutch gait, the nurse should instruct the patient to
move:
a. both crutches and the affected leg first, then the stronger leg.
b. the right crutch, left foot, left crutch, and right foot in sequence.
c. the left crutch and right foot, then move the right crutch and left foot.
d. both crutches, then lift and swing the legs forward as far as the crutches.
ANS: A
The proper sequence for the three-point crutch gait is: begin in tripod position, advance both
crutches and the affected leg, and then move the stronger leg forward, stepping on the floor.
This is the proper sequence for the four-point gait, the two-point gait, and the swing-to gait.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 241


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

19. A patient with left hemiparesis is using a quad cane for ambulation. Which of the following is
the correct technique for the nurse to use in teaching the patient?
a. Use the cane on the right side, with the cane moving forward first.
b. Use the cane on the left side, with the left leg moving forward with the cane.
c. Use the cane in either hand, with the right leg moving forward first.
d. Use the cane in either hand, with the left leg moving beyond the forward
placement of the cane.
ANS: A
To correctly use a quad cane, the patient places the cane on the side opposite the involved leg.
This provides added support for the weak or impaired side. Ambulation then begins by
moving the cane forward 6 to 10 inches (15 to 25 cm), keeping body weight on both legs. The
weak leg is then brought forward even with the cane while the body weight is supported by
the strong leg and the cane. The strong leg is then advanced past the cane. Moving a leg and
the cane forward at the same time will compromise balance and increase risk of fall.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 245


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Ambulation With a Cane KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. The patient had a stroke and is currently immobile. The nurse realizes that increasing mobility
is critical because immobility can result in alterations in which of the following? (Select all
that apply.)
a. Cardiovascular function
b. Pulmonary function
c. Skin integrity
d. Elimination
ANS: A, B, C, D
When mobility is altered, many body systems are at risk for impairment. Impaired mobility
can result in altered cardiovascular functioning, disruption of normal metabolic functioning,
increased risk for pulmonary complications, the development of pressure ulcers, and urinary
elimination alterations.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Complications of Immobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The nurse is caring for an immobile patient. Which of the following may help reduce the
hazards associated with immobility? (Select all that apply.)
a. A high-fiber diet
b. Frequent repositioning
c. Muscle and joint exercises
d. Increased fluid intake
ANS: A, B, C, D
Frequent repositioning, deep breathing and coughing exercises, muscle and joint exercises,
increased fluid intake, and dietary intake of foods containing fiber are examples of measures
that help to reduce the hazards of immobility.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 221


OBJ: Discuss the hazards of immobility. TOP: Prevention of Complications of Immobility
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The nurse is applying a CPM machine to the patient’s leg. To do so, she must: (Select all that
apply.)
a. provide analgesia 1 hour before starting the CPM.
b. stop the CPM when in extension and place a sheepskin on the machine.
c. align the patient’s joint with the CPM’s mechanical joint.
d. secure the patient’s extremity tightly with Velcro straps.
ANS: B, C
Provide analgesia 20 to 30 minutes before CPM is needed. Stop the CPM when in extension.
Place sheepskin on the CPM to ensure that all exposed hard surfaces are padded to prevent
rubbing and chafing of the patient’s skin. Align the patient’s joint with the mechanical joint of
the CPM.

DIF: Cognitive Level: Application REF: Text reference: p. 232


OBJ: Identify significant assessment data to be noted before and during the use of a machine.
TOP: CPM Machine KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. Factors that contribute to the development of DVT are: (Select all that apply.)
a. elevated sodium (Na+) levels.
b. hypercoagulability of the blood.
c. venous wall damage.
d. stasis of blood flow.
ANS: B, C, D
Three elements (commonly referred to as Virchow’s triad) contribute to the development of
DVT: hypercoagulability of the blood, venous wall damage, and stasis of blood flow.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Understand the pathophysiology of the development of DVTs.
TOP: Deep Vein Thrombosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

COMPLETION

1. ____________ refers to an ability to move about freely.

ANS:
Mobility
Mobility refers to an ability to move about freely.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Mobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. A person’s inability to move about freely is known as _______________.

ANS:
immobility
Immobility refers to a person’s inability to move about freely.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Immobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

3. A drop in blood pressure that occurs when the patient changes position from a horizontal to a
vertical position is known as _________________.

ANS:
orthostatic hypotension
Orthostatic hypotension is a drop in blood pressure that occurs when the patient changes
position from a horizontal to a vertical position.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 236


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Orthostatic Hypotension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The patient is performing ROM exercises independently. These are known as __________
exercises.

ANS:
active ROM
ROM exercises may be active, passive, or active-assisted. They are active if the patient is able
to perform the exercises independently and passive if the exercises are performed for the
patient by the caregiver. The exercises are active-assisted if the patient is able to perform
some of the actions independently with support and assistance from the caregiver.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 222


OBJ: Discuss indications for performing ROM and isometric exercises.
TOP: Active Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. Static exercises that involve tightening or tensing of muscles without moving a body part are
known as ______________.

ANS:
isometric exercises
Isometric or static exercises involve tightening or tensing of muscles without moving body
parts.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 227


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Exercises KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

6. _________________ increase muscle tension but do not change the length of muscle fibers.

ANS:
Isometric contractions
Isometric contractions increase muscle tension but do not change the length of muscle fibers.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 227


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Contractions KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

7. Virchow’s triad (hypercoagulability of blood, venous wall damage, and stasis of blood flow)
has been found to contribute to ________________.

ANS:
deep vein thrombosis (DVT)
Three elements (commonly referred to as Virchow’s triad) contribute to the development of
DVT: hypercoagulability of the blood, venous wall damage, and stasis of blood flow.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 237


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Deep Vein Thrombosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
8. The nurse is concerned that the patient may fall while he is ambulating. To help her maintain
control while the patient walks, the nurse may apply a ______________ around the patient’s
waist.

ANS:
gait belt
A gait belt encircles a patient’s waist and has space for the nurse to hold while the patient
walks. This gives the nurse better control and helps to prevent injury.

DIF: Cognitive Level: Application REF: Text reference: p. 240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Gait Belt KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
Another random document with
no related content on Scribd:
"Oh, no, I never learned cricket."

"And what do you do?" Nasmith inquired. "How do you pass the time?"

"I come here to read—Edward is noisy sometimes—and I like to see the


mountains."

"Won't you ever come to see us again? My nieces ask about you and
talk about you day after day."

"No, I can't do that now. My father would not like it."

"But he was very friendly last year and this spring he asked me to do
some important business for him."

"Yes, but I am not so free as last year."

"Why?"

Nancy found this question hard to meet even in English; in Chinese she
never would have dreamed of answering. But foreigners, she had
understood, discussed these things without reticence.

"My father has promised me to be engaged, to be married."

"Yes, but that is four—or is it three—years away."

"No, I am to be married soon—in two months."

Nasmith looked at her in dazed unbelief.

"Your father said you were not to be married till you were twenty."

"I changed that—I asked to be married earlier."

Nancy went on quite naturally from one confession to the next, talking
frankly on the banned subject as though thirteen years of Chinese life had
not forbidden fear. She liked the thrill of breaking such unwelcome news to
the friend she trusted so oddly.
"You changed it! Do you like the thought of this marriage?"

"I don't know—I was tired of the house, tired of the women, tired of
sewing."

"And do you think that there won't be a house and women and sewing
after you are married?"

"They will be different."

It was pleasing to meet someone who thought of her part in the bargain
that had been made.

"Different!" exclaimed Nasmith. "Ah, Nancy, it will be worse drudgery


than anything you have known. You speak like a child. You don't know
what you are saying. Do you think marriage is play?"

"I have to be married. My father said so."

"Do you know what your father did?" said the man, emboldened by his
pity. "Do you know that your father offered to marry you to me?"

This was a question the girl was wholly unready to face. The swift
progress of their conversation had carried her too far.

"And I refused," said Nasmith, determined to have it out, "I refused


because he asked impossible terms. He wanted to keep you till you were
twenty, would not let you go to school as I asked, would not let you be
brought up with my nieces. I was a fool. I should have kept my claim upon
you. You are not Chinese, Nancy, you have no right to be Chinese. And
now you are to be thrown away because of my obstinacy and your father's
blindness."

"You are not my father," said the girl indignantly; "he is not blind. I am
Chinese. I am Chinese—I must go home. I talk too much."

She stood up. Anger and despair fought in her brain. She felt helpless
before Nasmith's outspoken manners, a prey to her stupid frankness in
encouraging him.
"Don't go," begged the man. "I suppose you think I am rude, but I had to
speak out my mind. It is our Western way, you know. I keep forgetting you
are not used to it. I can't keep quiet when I see anything as wicked as this
marriage to which you are being sacrificed. If I went to your father to-day,
don't you think he would hear me? If I told him to have his own way, to
keep you where he pleased till you are twenty, couldn't we break this
engagement?"

"We don't break engagements," the girl answered proudly. She turned
cool, almost cold in her firmness, now that Nasmith had been betrayed into
what she felt was a dishonorable weakness. "My father doesn't change and I
don't change. We have promised."

"Fiddlesticks! Engagement is not marriage. It was your father's first


wish, remember, that I should marry you."

"My father has told me his wish. I am engaged."

"Can you read this?" persisted the man, drawing from his pocketbook a
copy of the scrolls Herrick had written. "This is what your father wrote.
Can you read it?"

Nancy looked at the paper curiously.

"Did my father write this for you?" she asked.

"Yes, he wrote it for me last year, the day when we brought you home
from my sister's house. He told me these characters had a meaning for me if
I could understand them."

"They have a meaning," the girl admitted.

"What meaning?"

"You are the sun," she said.

"Of course; but who is the moon?" he demanded.

"I was the moon—then—last year."


"You are still the moon," he declared. "They were not written merely for
last year."

Nancy did not answer him. The copied characters of the scroll had been
like a glimpse into her father's mind. She had played so long with these
riddles as to be profoundly moved by what she saw so clearly her father had
meant to be prophecy. Great was her reverence for the written word. She
was like the Chinese who will not allow even a scrap of printed paper to be
trodden underfoot, like the governor who forbade newspapers to be used for
wrapping parcels because this was treating characters shamefully, showing
despite to the very means of the culture which sages and poets had labored
to create. For scrolls her deference was superstitious. They were oracles,
working out their own mystical fulfillment. Versed as she was in their
subtlety, in their history, in the earth-shaking powers of a single well-
written character, the byplay of allusion which had torn down dynasties or
raised men to favor with the Son of Heaven, she looked with fear and
bewilderment upon her father's message as though she were reading a
mandate of the gods, for the scroll expressed her father's belief and his wish
that she should be the wife of this stranger from the West.

"I am engaged," she repeated as though she were defying heaven. "We
have promised!"

Nasmith saw this could not be argued further. More words only would
make the girl stubborn, perhaps lose him the chance of seeing her again.

"Very well, we won't debate the matter," he said, "but do you think your
father would let you come to stay for a few days with my sister—and your
brother, of course? My nieces will never be satisfied to miss seeing you; if
they heard I had met you, they would send me back for you. And this is not
the request of a stranger, you know. After all, I am almost a guardian. You
will come, won't you?"

"Why?"

Nancy was in a contrary mood.


"Why?" echoed Nasmith impatiently. "Why? I should not have thought
you needed to ask that question. Does not your memory suggest reasons
enough? After all, Nancy, you won't find friends so plentiful in this world
that you can afford to neglect those you have."

"Perhaps Edward can come," she admitted, "but if I can come—I don't
know. It is different for me because I am engaged."

"Will you ask your father?" Nasmith persisted.

"Yes, I will ask him," said Nancy; and away she went swiftly, like the
quiet, swift descent of evening.

Nasmith did not try to follow, although it was high time for him to be
swinging into his sturdy stride homeward. He felt as much amazed by the
riddles as Nancy herself. Suddenly it occurred to him that this was only his
second meeting with the girl—two meetings, and these a year apart. He
could not account for the intense feeling which made him still loiter in this
spot as though all that was real of her were lingering with him. He could not
understand the attraction which held him. Was there real insight, after all,
expressed in those words whose meaning with baffling enlightenment he
now realized?

The sun moving to the west kindles a splendid beacon for the moon;
The moon following from the east tenderly displays the
reflection of the sun.

Or had these words, slowly maturing in his mind, worked their own desire
for fulfillment? He loved these mountains the sun had painted in broad
sweeping colors, to which night was hurrying to put in shadow. He regarded
them tenderly; they seemed to breathe of Nancy, to sing of Nancy, with the
old time-worn cadence of the land whose tongue she had learned. Ah, what
a beacon he could light for her, what a splendid beacon he must set blazing!
She could not, she should not, be lost to him!

So the serene glow of evening had helped him find himself, had made
him resolute, had sent him home resolute, after a year of fighting shadows.
Nancy, in her own way, was tranquil. The habit of taking life as it came
enabled her to speak simply to her father about this meeting with Nasmith
and about his request. The father was still indulgent. He did not need to
remind himself of his promise; this was Nancy's summer. He had screwed
his will to its final pitch when he consented to the date of her marriage.
Nothing more seemed to matter; nothing more was he willing to debate. Let
life run as it chose.

"I see no harm in it," he said, dealing with Nasmith's invitation. "Mr.
Nasmith is a man I trust and his family, so far as I met them, are delightful.
The change will be good for you both. I will send a man the first thing in
the morning to tell them you are coming, and by the afternoon the chairs
can be ready for you to start. Amah of course must go. They're sure to have
room for her."

In this matter-of-fact way Herrick granted the request as though it were


business of no concern. Nancy was not so sure. She too could not rid her
memory of the prophetic lines her father had written. The words had caught
in her brain. She repeated them till she fell asleep and repeated them again
in the morning when her spirit had become infected by Edward's growing
excitement. With great ado the little procession set out, the amah waving
more farewells than a traveler bound across the ocean. Nancy was not
insensible of the bustle. She was both glad and afraid, timid and joyful, but
she abandoned her body to the motion of the chair, lying back with eyes
half closed, while the sun beat hot through the screened window. She was
content to let her spirit be carried, like her limbs, with the inertia which
leaves every directing impulse to destiny. "The sun—the moon; the moon—
the sun—t'ai-yang, yueh-liang; yueh-liang—t'ai-yang," the words made
their own drowsy refrain to the slogging pace of the coolies.

Deep was the silence which had fallen over the deserted household.
Herrick had not realized how much he would miss these children whom
never before had he allowed to go away from their home. The sun shone
vacantly on the temple; in the evening he walked with Kuei-lien in the
moonless dark, passing the tomb of the monk and standing pensive on the
little platform which overhung the ravine. He was like a lonely child, but
afraid of something worse than the loss of Nancy and Edward, afraid of the
solitariness of death, which seemed to threaten him from the deep shadows
of the mountains.

Kuei-lien too felt the spell and did little to cheer him. The song she sang
was sad, the old tragic tale from The Three Kingdoms of the first break in a
brotherhood, which had become classic, the brotherhood of the Peach
Orchard, wherein three heroes had stood gayly steadfast to each other
through years of war, only to be separated by death at the last. She sang the
story Herrick knew so well and loved for its sombre beauty: how Liu Pei,
King of Shu, had wakened from troubled sleep to see the ghost of his blood-
brother, Kuan Yü, not knowing it was a ghost, not knowing he had been
slain.

A cold gust of wind blew in his chamber; the lamp flickered and
became bright again. Liu Pei looked up and saw a man standing behind the
lamp.

"What man are you that comes in the dead of night to my chamber?"

The man did not answer. Liu Pei, in alarm, got up to look. It was Kuan
Yü who was hiding behind the shadow of the lamp.

Liu Pei exclaimed:—

"Ah, my brother, have you been well since we parted? You must have
great reason to come thus in the depth of night. You and I are the same bone
and flesh; why do you show this deference?"

Then Kuan Yü wept and said:—

"Brother, raise your armies and avenge me. Wipe my wrongs clean as
snow."

He finished speaking. A cold wind arose. He had vanished. Suddenly


Liu Pei awoke; and it was a dream.
Kuei-lien's voice made the tragedy seem real to her master—the terror
of that awakening. She told how at the third watch Liu Pei sent for his
minister, K'ung Ming, whose strategy and knowledge of the stars and
unworldly faithfulness had won him this kingdom in the west. K'ung Ming
tried to comfort him out of his fear, but when he had left the presence of the
King he met a friend who told him that there were evil rumors abroad about
the fate of Kuan Yü. Then K'ung Ming unburdened his heart.

"To-night I have seen a sign in the heaven," he confessed. "I saw a star
fall over Chingchou and I know that Kuan Yü has met with evil there. But I
am afraid of my master's grief and dare not tell him."

Even while the two were speaking a man suddenly came forth, caught
hold of K'ung Ming's sleeve and said:—

"If there is evil news, why do you deceive me?"

K'ung Ming looked; it was Liu Pei.

"Why do you distress yourself over uncertain news?" he said. "Why let
yourself be so unprofitably sad?"

Liu Pei answered:—

"I and Kuan Yü have sworn to live and die together. If he has fallen,
how can I stand alone?"

Then, one by one, disturbing the peace of the night, came messengers.

"Kuan Yü is defeated."

"Kuan Yü is betrayed."

And, before it was light:—

"Kuan Yü is slain."
Liu Pei, when he heard it, gave one great cry and fell fainting to the
ground.

Herrick listened as though these things had not happened centuries and
centuries ago, as though the three men still whispered beneath the flickering
torches of the palace. He saw the King cast down by his mighty grief to the
cold stones of the pavement. It was as if Kuei-lien herself had sung away
the Golden Age and its heroes. He turned to the girl; her face was almost
luminous in the dark. His heart was too burdened for speech. She had sung
away his own Golden Age, sung away his lustihood and strength.

"Why do you deceive me, ah, why do you deceive me, Kuei-lien?" he
asked sadly, echoing Liu Pei's words with a meaning which the girl
understood for a moment, but never understood again.

CHAPTER XXII

Long before this Nancy was happily asleep. Thoughts of sun and moon
had gone glimmering before the joy of her welcome. Helen and Elizabeth
and their uncle had come far along the road to meet the chairs of their
guests and out they pulled Nancy and Edward for a gay walk home. It was
so like their coming a year ago and so different, the same dusky winding
down the mountain path to the settlement, the same bright lights and noise
of music from a score of summer homes, the glimpse of the verandah
through the trees with servants bustling to set knives and forks on the table.
But Nancy came now without fear, like one who had her own place in this
merry family. She welcomed Mrs. Ferris's arms and Mrs. Ferris's kisses and
followed the chattering twins to the room she was to share with them.

Not even dinner could frighten her, nor her place of honor at Nasmith's
right. She caught sight of the amah's face beaming through the door and
infectious echoes of her laughter over being once more, after all these years,
with people whose ways she understood. The old servant was holding forth
princely gossip in the kitchen and the same light-hearted key prevailed in
the conversation of the table, so that Nancy's eyes glowed and her lips
broke into more smiles than they had shown for months. Hosts and guests,
one and all, as if by unquestioned consent, had put away troubling thoughts
and forgotten the sorrows of the morrow in the joys of the day. Beresford's
quips were never more brilliant. Even Nasmith himself forgot his pain and
was satisfied to have Nancy next to him, where he could watch glints of
light from beneath her long eyelashes as she answered the amused irony of
his sentences.

By common arrangement it was decided that Nancy and Edward must


be English during the two weeks of their visit. Yet it was a surprise to the
man who hardly dared admit himself her lover when he saw the girl in the
morning. Elizabeth and Helen had repeated their magic and led out a
maiden who, save for a little hesitating awkwardness, might have belonged
to the West through all her seventeen years. Edward with his usual
carelessness of clothes had slipped easily into shirt and trousers, but Nancy
wore her dress of blue muslin with a deliberate grace which charmed the
attention of those who watched her walk slowly forward. The curve of her
throat had never had fair play behind the high collar of her Chinese jacket;
her hair was gathered loosely from her forehead and bound round her head
with just that effect of wind-blown negligence which the twins, who had
shared between them the task of dressing their guest, delighted in as the
conspicuous triumph of their labor. But the girl still moved stiffly, not quite
sure of herself before Nasmith's approving glance, not quite sure of her bare
arms and the tenuous clothing of her legs, a little frightened for the
exiguous under fabrics into which they had made her step, not thoroughly
certain the men could not read the secret of these dainty garments and how
insecurely they seemed to cling to her shoulders. She kept her hands stiffly
at her sides lest her skirts, by which she was embarrassed enough to expect
any mischief, part company from the black silk stockings which
overreached her knees.

Helen and Elizabeth laughed at her qualms. They could not believe that
trousers seemed more modest to Nancy than the very ordinary rough-and-
tumble dress in which they had clothed her. As they predicted, her shyness
soon passed, her shyness before all except Nasmith. On him her eyes
persisted in lingering, yet she always flushed when he turned to look at her.
The enigma of the couplet her father had written still drew her fancy toward
him while it made her as quickly anxious to hide. And Nasmith, much as he
tried to be cool, could never disguise his interest in this pale stranger who
for the breadth of a year had lived like an incessant trouble in his brain.

His nieces, however, for the first few days took command of their guest.
They postponed talk of Nancy's marriage,—they could not bear to broach
the subject nor to think of it,—and gave up the time to picnics and
swimming parties and tennis. Nancy enjoyed the long walks, the start in the
cool of the morning, the chattering climb to some far-off temple where the
trees provided shade and the bushes, tangling among boulders, gave covert
in which the girls swiftly stripped off their clothes and climbed into
swimming suits for an hour's diving and splashing in a clear warm pool.
Though she envied them, she never could quite be persuaded to join them.
Edward emerged fearlessly and was soon out with the men, swimming like
a young spaniel, but his sister allowed herself only once to be led charily to
the brink of the pool. She enjoyed watching the others at sport, the glossy
figures of the girls as they climbed dripping on to the rocks, the antics of
Beresford, who swam under water and seized his shrieking victims by the
ankles, Nasmith's supple strength, which helped him, without apparent
effort, to outdistance the whole of them in the length of his dives and the
swiftness of his stroke through the water.

Then came tiffin, spread on a white cloth beneath the pines. There was a
fastidious vein in Mrs. Ferris's nature which would not let her dispense with
what she called the decencies of life, so that these meals, to the scoffing
amusement of her brother, never lacked the cloth and the dishes or the
glittering silver—she would die from starvation rather than eat without
them, Nasmith declared. Nancy heard the approving comment of the old
amah, who was telling the other servants that it was just this way that the
first Mrs. Herrick, the real Hai t'ai-t'ai, used to serve picnics in those palmy
days when she reigned as first Lady of Amoy. Nancy tried hard and gravely
to connect this actual link with the legend of her mother.
Luncheon was followed invariably by a long, drowsy nap. This Nancy
liked best of all, for she could stretch herself luxuriously in the shade of the
bushes and talk idly with Helen and Elizabeth till the sun, shining through
the leaves, filled her veins with its warmth and beguiled her into sleep. The
birds sang more lazily, the breeze barely stirred the pines, the water went
deviating through the rocks with a silver tinkle, the heat glimmered before
her half-shut eyes; she would wake to find it was tea time and the girls
hastily combing their hair or tightening the garters round their stockings.
Then she too would jump up, shake her dress free of pine needles, dash cold
water into her face, and hurry to take her place beside the festive cloth.

At tea time the party was always at its gayest. The picnickers lay or sat
cross-legged on the ground and watched the golden sparkle of the tea as it
was poured into cup after cup. The steaming liquid refreshed their spirits,
gave them appetite for sandwiches and dainty frosted cakes. Nancy was so
happy that she did not think of herself as a stranger but fell easily into
family ways and smiled at the family jokes, at the teasing of the twins and
their changeable-mooded sister, Patricia, who was blossoming into a child
of mercurially gay and serious fancies. Edward adapted himself even more
quickly; he both teased and was teased, flinging off banter as he flung the
spray from his forehead when he was swimming.

He could swagger and brag up to the last inch of David's schoolboy


manner. But Nancy, though she was a laughing partner to all this jesting,
never quite became fair target for their jokes. Her destiny lurked, unspoken
of yet not unregarded, in her eyes.

Nevertheless, she was braver than the others in putting it out of mind,
and no one could have told, from watching her walk blithely home, now
talking with one, now with another of the party, that a heavy doom hung
over her, a doom which made the unpredictable future of her companions
seem play by comparison. It was apparent, of course, how the interests and
affection of the whole family hovered round her, but then she was
singularly lovely; her grave beauty had been made to attract interest and
affection.

She was enjoying herself, wholly careless of the passing of time, only
content that days like these should go on forever. She looked eagerly for the
lights of the bungalow gleaming through the trees, then the bustle, the
washing, the changing of clothes for dinner. Such was the magic of the
twins, who rifled their wardrobe between them, that she would appear in
delicate silks trailing halfway to her ankles, a circle of amber beads flashing
their fire at her throat, a ribbon of ivory satin half lost in her black hair, but
always the pensive look in her eyes, her lips, her whole bearing, which
suggested passion and desire so many ages older than the transient fashions
she graced.

Nasmith watched her with hungry eyes and it was only Nancy's
absorption in her two friends which kept his secret from being guessed. Her
attention, for the moment, was gladly filled by the commonplaces which
were such a luxurious novelty to her. The gramophone, the games, the
bedroom gossip which trespassed on their sleep still made every evening
exciting.

On Sunday they took her to the little Anglican church. They expected
the occasion to be a great moment in her life, but they overestimated her
capacity for religious feeling. The experience was neither more nor less
than the many strange practices to which her eyes were being opened.
Nancy had heard of the Christians,—she had been reminded that their
religion had been her mother's,—but she felt no violent curiosity about their
ways. It seemed natural enough that the foreigners should have their own
religion, and one god the more was additional security in time of trouble.
She thought the altar with its cross seemly enough, so far as she thought of
it at all, but she was puzzled by the complications and the uncomfortable
formality of the service and wondered why the priest wore vestments of
funereal white and black. To the sermon she could give no response,
having, even where she understood the sentences, not the faintest clue to its
topic.

She did not criticize; no doubt this queer round of prayers and hymns
pleased the gods; there were so many ways of pleasing the gods. But her
attention was mainly caught by the people who sat round her. The presence
of so many foreigners frightened her; she did not like their peculiarities of
dress, the untidy personal touches of fashion, the hats of the women with
their meaningless flowers and fruits and vegetables, nor did she like the
beards and moustaches of the men. Instinctively she drew closer to her
friends; she understood them even though she resented the ease with which
they joined in this alien worship, but as for the others, they were strangers,
no kin of hers.

Her hosts were disappointed because she could give no coherent


impressions of the service. Not that their religion was too serious a burden
to themselves; but it went with the proper order of things, with the
established decencies of life, that they should be called "Dearly beloved
brethren" once a week, and the shallowness of their own spiritual education,
the very small teaching their Church had given them, the easiness of the
demands it imposed, made them squirm at the thought that Nancy, after all,
was a heathen. They had never analyzed the term beyond the vague notion
that she must worship idols—a really undignified thing to do. They were
too ignorant of what they themselves believed to venture into a debate with
the girl. So they looked at her with concern, hoping the service might have
saved their pains by prompting godly instincts, and feeling chagrin over so
blank a failure. They were well-meaning people; they felt the presence of a
duty, a duty they were both too helpless and too nice to perform. For a few
hours Nancy was lonely and longed to be back in her father's house.

But by Monday religion had been comfortably stowed away for another
week and the very faint shadow of misunderstanding between Nancy and
her hosts had been dispelled. She was up early, batting a tennis ball with
provoking awkwardness, but happy because she and Nasmith beat every
combination the family could muster against them. The exercise, the brisk
morning air, the smiles and applause of her friends, made her know she was
in favor again. The girls would have laughed if they had guessed yesterday's
scruples: to think that of all their many differences they should quarrel
about religion! A more intriguing subject dawned upon their minds.
Nasmith's secret, his passion for Nancy, became suddenly plain to eyes that
had been blind.

"I do believe Ronald's in love with Nancy," Helen blurted to her sister.
In the first delicious shock of discovery they matched notes. The fact could
not be doubted. Although no special indiscretion had betrayed the man, the
tale of his gaze which followed Nancy's every movement had spoken too
clearly.

"How splendid!" cried Elizabeth. "Why didn't we ever guess it before?"

It was a match so suitable, the girls both agreed, that it ought to have
been promoted, even without the convincing proof of Ronald Nasmith's
affection. Here was the one acceptable way of saving Nancy.

They rushed to their mother with the news.

"Ronald loves Nancy," they declared in concert. "We are sure of it."

"I know he does," said Mrs. Ferris quietly.

"But why didn't you tell us? We ought to have helped them. What pigs
we've been, keeping Nancy all to ourselves!"

"It's Ronald's problem," smiled the mother. "He will have to manage it
in his own way."

"But aren't you glad?"

"I am—very glad, if everything turns out well. But it won't be easy.
Nancy is in a difficult position, and she is young."

"Everything must turn out well," vowed Elizabeth. "Do you think
Nancy likes him?"

"Nancy is a very inexperienced child. How can she know what she
likes?"

"She's older than we are," Helen protested.

Mrs. Ferris smiled again.

"You are only children yourselves."


"Pooh, mother," the daughter exclaimed, "don't talk stuff like that to us.
You ought to know better. Even Pat wouldn't swallow such old-fashioned
language. What do you really think about Nancy? Does she like Ronald?"

"I should not be surprised if she did," Mrs. Ferris conceded, with the
amused, secretive look which convinced them that she was stating only half
of what she had seen.

"Then we must help them."

"Don't be too impetuous, my dears. I should like Ronald to have Nancy,


mind you; she is a very sweet girl. But she isn't free, you know, and unless
Ronald is sure of getting her, it might make her miserable for life if she
liked him too well. You know how she's been brought up and you know that
her father has arranged for her to be married. We have to reckon with the
father. And we have to reckon with her too—alas, she is a more obedient
daughter than mine. Suppose she should come to love Ronald and then be
forced into marriage with that Chinese—what would her life be?"

"But you don't really consider such a ghastly event possible!" cried
Elizabeth, her eyes ablaze with indignation. "We've got to prevent it, and
this is our chance."

"We have to consider it, whether we wish to or not," the mother


answered. For the first time she did not smile. Her eyes were sad.

Despite this reluctant warning, the twins were convinced of their duty to
further the match. By fair means or foul it had to be achieved. They were
not afraid of Nancy's father nor did they weigh very seriously the fact of her
engagement.

"He seemed a nice old man," said Helen, "and if he were likely to
disapprove, why should he let Nancy visit us?"

What appalled the girls was the time they had lost, the five precious
days in which they had done nothing to help Nancy and Ronald to an
understanding. They must make immediate amends, use every occasion to
leave the man and the girl to themselves. But occasions did not come so
easily as they wished. The habit of even five days could not easily be
broken. Nancy seemed to detect each effort at desertion and cling more
nearly to her friends. They could not lead her bluntly to Nasmith and say,
"There you are; love him." They could only steal away on this pretext and
that, but these manufactured meetings left an atmosphere of constraint, so
that the girl grew shy in the presence of her lover and seized her own
chance to escape. And there was always Patricia or David or Edward in the
way. Half an evening was consumed in luring them out of the room, for the
younger children, suspicious of being beguiled out of some advantage, like
a child enticed to bed when fun is brewing downstairs, held their places
with maddening obstinacy.

"I declare," stormed Elizabeth, "marriages may be made in heaven, but I


wish there was a little more help in making them on earth!"

CHAPTER XXIII

The visit was almost at its end. The girls were in despair.

"We won't let you go home," they told Nancy. "You must have another
week, at least. Surely your father won't mind."

"Perhaps he won't," she agreed, "but I must go back and ask him."

She was no more ready than they were to have her stay finished. Time
had gone so swiftly. The first few days she had been careless of its passing,
as though she had the leisure of years before her, but now each day was
oppressed by the closer approach of the end. It would be the end to so many
things, the end to her youth, to her freedom, her all too brief season of play.
Nancy wished at times she had never known these friends; she would not
have missed them so. Barely a month remained till her marriage. She
looked at the moon shining through the trees. Even now it was at the first
quarter. The next time she should see it thus, she would be back in Peking,
the centre of odious preparation, half enslaved already, and before she could
see it again she would be married, hidden in some brawling Chihli village
where her mother-in-law might not give her time to watch the slow
processions of the sky.

The praise of the twins had awakened a delight in her own beauty. She
would stand slowly undressing before the mirror, extending her arms,
admiring the rounded softness of her shoulders, the glint of light upon her
long silk stockings. She reddened with shame and with fear at the thought
of giving her body to the mercy of a stranger.

Not new thoughts were these, but for the first time intimately felt, and
by contrast the quick comradeship which prevailed in the Ferris family
made their home the treasure-house of all things desirable. Whatever she
might predict of her future home, she knew it would not be like theirs. She
dared less to think how different it might be. She wanted security. She
wanted peace of soul. She wanted the grave trust of a man like Nasmith.
She did not know that, with all her rapt joy in the company of the twins, her
one desire from waking till sleeping was to appear lovely in his eyes. "I was
the moon—I was—" she mused once or twice, and checked herself
dreaming before the long mirror.

Nasmith too had come down from counting days to counting hours. A
whole ten days with Nancy near—they had promised so much and been
nothing but tantalization and sorrow. And now but one day lay before him.
The conversation of the dinner table turned to his rescue of Nancy a year
ago. Beresford revived the story with sundry mock-heroic touches,
descanting upon the execution Edward had done with his bow till he made
their intervention seem merely a belated attempt to save the lives of the
monks.

"Shall we go back there, Nancy?" said Nasmith, half in play, half trying
to veil the bitter seriousness of his eyes, "and see if we can remember it all?
It was so long ago, it has begun to seem almost a joke."

His suggestion was taken up eagerly by the girls. They had not
consented to thinking of the morrow as Nancy's last day among them; she
must win her father's agreement to a longer visit; but, if last day it were, a
slight trembling in Ronald's voice told them he would make the most of it.
So early the next day they started with all the paraphernalia of these outings
to make holiday high among the rocky shoulders of the mountains. The sun
shone in broad waves of light down the grassy slopes; the paths were still
wet with dew.

"Who shall lead the way?" Nasmith asked.

"You and Nancy, you must be the pilgrims," called out Beresford
cheerily.

The twins had trusted him with their secret.

"Do you love Nancy?" Helen had demanded of him the night before.
"Yes, of course I love Nancy," he had answered.

"Oh, don't be stupid," the girl retorted, stamping her foot. "Do you love
her?"

"I will, if you wish," Beresford answered gallantly.

"Well, I don't wish it. If you're really and truly sure you don't love her, I
want you to keep David and Edward in hand when we go to the temple; find
a tiger for them, even if you have to buy one—"

"Couldn't I be a tiger myself? I look well in stripes,—some have been


ungracious enough to suggest my wearing them permanently,—and if you
can give me some hint of how a tiger roars or whether a tiger does roar or
merely sits on his hind feet and purrs,—I won't do that, mind you,—"

"I am not joking," Helen broke in. "I want you to keep the boys amused
so that Ronald can have a chance."

"Right-o," he said, suddenly understanding. He was a little saddened,


for the habit of seeing Nancy was growing on him.

"Well, I'm late in the race," he thought to himself. "I can't complain."
So, at Helen's command, he was tactfully alert to every chance of helping
what he supposed, in his simple way, were lovers.
"You are the pilgrims," he called, "you must brave the thorny places of
the wilderness. Young Edward and I will hold our trusty bows in reserve. If
you chance upon peril, give three piercing cries,—you'd better make them
two shorts and a long so we won't be led astray on other adventure and fail
you in your need,—three piercing shrieks, and we'll tumble to your
assistance."

Laughingly Ronald took up his post of guide, with Nancy halfway


between him and the twins, while Beresford kept his two young cubs in
leash by the sheer interest of his talk, and hallooed cheerfully to Mrs. Ferris
to make sure that she and her mountain chair were still pursuing.

"Though fa-int, yet pursuing, we go on our way,"

he would hum, and then break off, reproaching himself with a grimace for
such irreverent use of a hymn. Meanwhile the twins, satisfied with the
arrangement of the party, slowly widened the interval between themselves
and Nancy, very cautiously, of course, not too quickly nor too far, lest the
girl suspect, yet far enough so that her walking and talking with Ronald
could become the habit of the day.

"Well, here's the grove," said Ronald, at last. Nancy had been taught to
call him by his name, "the communism of the family," he had assured her.
"Now what shall we do?"

They waited for the party to draw up.

"I smell water," exclaimed Mrs. Ferris.

"There is a stream in a ravine close by," offered Beresford, who had


explored these mountains inch by inch with his friend.

"Splendid, just the place we need for tiffin. Tiffin before temples, my
dears."

They arrived at the edge of the ravine and slipped down the gravelly
path to the rocks below.

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