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Test Bank for Medical-Surgical Nursing: Clinical Reasoning

in Patient Care, 7th Edition, Gerene Bauldoff, Paula
Gubrud Margaret Carno
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Solution Manual for Medical-Surgical Nursing: Critical

Thinking in Patient Care, 5th Edition, Priscilla LeMone,
Karen M. Burke Gerene Bauldoff
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Test Bank for LeMone and Burkes Medical Surgical Nursing
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Medical-Surgical Nursing Patient-Centered Collaborative

Care Ignatavicius 6th Edition Test Bank

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example of the core competency evidence-based practice. Collaboration between disciplines to provide
continuous and reliable care is an example of the core competency teamwork and collaboration.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage,
age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in
their care
NLN Competencies: Relationship Centered Care: Learn cooperatively, facilitate the learning of others
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1. Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.
MNL Learning Outcome: 10.5.4. Utilize the nursing process in care of client.
Page Number: 4

Question 2
Type: MCSA

The nurse is planning to utilize the core competency use informatics when providing patient care. Which action
should the nurse perform when using this core competency?

1. Change the sharps container in a patient’s room.

2. Document the effectiveness of pain medication for a patient.

3. Discuss the effectiveness of bedside physical therapy with the therapist.

4. Search through a database of articles to find current research on wound care.

Correct Answer: 4

Rationale 1: Changing the sharps container is an example of quality improvement.

Rationale 2: Documenting the effectiveness of pain medication for a patient is an example of patient-centered
care.

Rationale 3: Discussing the effectiveness of bedside physical therapy with the therapist is an example of
teamwork and collaboration.

Rationale 4: Searching through a database of articles to find current research on wound care is an example of use
informatics.

Global Rationale: Examples of the nurse using the core competency use informatics include the use of
technology to communicate, manage knowledge, reduce errors, and support decision making. The activity of
searching through a database of articles to find current research on wound care is an example of use informatics.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Changing the sharps container in a patient’s room is an example of quality improvement. Documenting the
effectiveness of pain medication for a patient is an example of patient-centered care. Discussing the effectiveness
of bedside physical therapy with the therapist is an example of teamwork and collaboration.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of
care
AACN Essentials Competencies: IV.1. Demonstrate skills in using patient care technologies, information
systems, and communication devices that support safe nursing practice
NLN Competencies: Knowledge and Science: Electronic databases; literature retrieval; evaluating data for
validity and reliability; evidence and best practices for nursing
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 1. Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information
technology.
MNL Learning Outcome: 4.3.3. Examine the treatments used for pressure ulcers.
Page Number: 4

Question 3
Type: MCMA

The nurse plans to implement evidence-based practice when providing patient care. Which activities should the
nurse perform?

Standard Text: Select all that apply.

1. Participate in education and research activities when possible.

2. Integrate research findings with clinical care to maximize patient outcomes.

3. Serve on the committee to create critical pathways for patient care.

4. Reinforce hand hygiene techniques with unlicensed assistive personnel.

5. Contact Environmental Services to report a malfunctioning infusion pump.

Correct Answer: 1, 2

Rationale 1: Participating in education and research activities when possible is an example of implementing
evidence-based practice in the provision of patient care.

Rationale 2: Integrating research findings with clinical care to maximize patient outcomes is an example of
implementing evidence-based practice in the provision of patient care.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 3: Serving on the committee to create critical pathways for patient care is an example of teamwork and
collaboration.

Rationale 4: Reinforcing hand hygiene techniques with unlicensed assistive personnel is an example of quality
improvement.

Rationale 5: Contacting Environmental Services to report a malfunctioning infusion pump is an example of

quality improvement.

Global Rationale: Participating in education and research activities when possible is an example of implementing
evidence-based practice in the provision of patient care. Integrating research findings with clinical care to
maximize patient outcomes is an example of implementing evidence-based practice in the provision of patient
care. Serving on the committee to create critical pathways for patient care is an example of teamwork and
collaboration. Reinforcing hand hygiene techniques with unlicensed assistive personnel is an example of quality
improvement. Contacting Environmental Services to report a malfunctioning infusion pump is an example of
quality improvement.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new
evidence into standards of practice
AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research
process and models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science; Defining what is evidence-based practice
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 1. Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.
MNL Learning Outcome:
Page Number: 4

Question 4
Type: MCSA

The community health nurse is planning to meet with several community members during a health fair. Which
nursing activity exemplifies the core competency patient-centered care?

1. Provide smoking cessation classes and literature.

2. Increase the hours for the physician to see patients.

3. Attend a continuing education program on clean water initiatives.

4. Evaluate the effectiveness of weight reduction strategies.

Correct Answer: 1

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 1: Providing smoking cessation classes and literature is an example of an activity to provide patient-
centered care.

Rationale 2: Increasing the hours for the physician to see patients is an activity to support the competency
teamwork and collaboration.

Rationale 3: Attending a continuing education program on clean water initiatives is an activity to support the
competency evidence-based practice.

Rationale 4: Evaluating the effectiveness of weight reduction strategies is an activity to support the competency
quality improvement.

Global Rationale: Activities to exemplify the core competency patient-centered care should be focused on
disease prevention, wellness, and promotion of healthy lifestyles. Providing smoking cessation classes and
literature is an example of patient-centered care. Increasing the hours for the physician to see patients is an
activity to support the competency teamwork and collaboration. Attending a continuing education program on
clean water initiatives is an activity to support the competency evidence-based practice. Evaluating the
effectiveness of weight reduction strategies is an activity to support the competency quality improvement.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human
experience
AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding
of human growth and development, pathophysiology, pharmacology, medical management and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings
NLN Competencies: Context and Environment; Knowledge; health promotion/disease prevention
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 1. Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information
technology.
MNL Learning Outcome: 5.9.4. Utilize the nursing process in care of client.
Page Number: 4

Question 5
Type: MCSA

The nurse is instructing a patient on weight reduction and smoking cessation. Which code of nursing practice is
the nurse implementing?

1. International Council of Nurses Code of Ethics for Nurses

2. American Nurses Association Standards of Professional Practice

3. American Nurses Association Code of Ethics for Nurses

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
4. State Board of Nursing Code

Correct Answer: 1

Rationale 1: The International Council of Nurses (ICN) Code of Ethics for Nurses specifies what nurses are
accountable for in terms of people, practice, society, coworkers, and the profession. The philosophical basis for
this code is that nurses are responsible for promoting health, preventing illness, and alleviating suffering.
Instructing a patient on weight reduction and smoking cessation exemplifies the ICN Code of Ethics for Nurses.

Rationale 2: The American Nurses Association Standards of Professional Practice are standards, not a code, and
focus on specific behaviors to address quality practice, practice evaluation, education, collegiality, collaboration,
ethics, research, resource utilization, and leadership.

Rationale 3: The American Nurses Association Code of Ethics for Nurses has nine statements that address the
nurse’s professional relationships, commitment to patients, patient rights, nursing practice, competency,
conditions of employment, and contributions to the science of nursing, collaboration, and nursing values.

Rationale 4: The state boards of nursing do not publish codes for nursing.

Global Rationale: The International Council of Nurses (ICN) Code of Ethics for Nurses specifies what nurses are
accountable for in terms of people, practice, society, coworkers, and the profession. The philosophical basis for
this code is that nurses are responsible for promoting health, preventing illness, and alleviating suffering.
Instructing a patient on weight reduction and smoking cessation exemplifies the ICN Code of Ethics for Nurses.
The American Nurses Association Standards of Professional Practice are standards, not a code, and focus on
specific behaviors to address quality practice, practice evaluation, education, collegiality, collaboration, ethics,
research, resource utilization, and leadership. The American Nurses Association Code of Ethics for Nurses has
nine statements that address the nurse’s professional relationships, commitment to patients, patient rights, nursing
practice, competency, conditions of employment, and contributions to the science of nursing, collaboration, and
nursing values. The state boards of nursing do not publish codes for nursing.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
AACN Essentials Competencies: VII.4. Use behavioral change techniques to promote health and manage illness
NLN Competencies: Context and Environment; Knowledge; health promotion/disease prevention
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome: 5.9.4. Utilize the nursing process in care of client.
Page Number: 9

Question 6
Type: MCSA

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
The nurse is providing patient care within the American Nurses Association Standards of Professional
Performance. Which activity is the nurse implementing?

1. Integrating research findings into practice

2. Implementing a patient’s plan of care

3. Evaluating patient progress toward identified outcomes

4. Analyzing assessment data to determine issues

Correct Answer: 1

Rationale 1: The nurse who is practicing within the American Nurses Association Standards of Professional
Performance would integrate research findings into practice. The standards focus on ethics, education, evidence-
based practice and research, quality nursing practice, communication, leadership, collaboration, professional
practice evaluation, resource utilization, and environmental health.

Rationale 2: Implementing a patient’s plan of care is an example of adhering to the American Nurses Association
Standards of Practice.

Rationale 3: Evaluating patient progress toward identified outcomes is an example of adhering to the American
Nurses Association Standards of Practice.

Rationale 4: Analyzing assessment data to determine issues is an example of adhering to the American Nurses
Association Standards of Practice.

Global Rationale: The nurse who is practicing within the American Nurses Association Standards of
Professional Performance would integrate research findings into practice. The standards focus ethics, education,
evidence-based practice and research, quality nursing practice, communication, leadership, collaboration,
professional practice evaluation, resource utilization, and environmental health. The other activities would be
implemented when the nurse is adhering to the American Nurses Association Standards of Practice.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new
evidence into standards of practice
AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research
process and models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science; Defining what is evidence-based practice
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
Page Number: 10

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Question 7
Type: MCSA

The nurse prescribes strategies and alternatives to assist a patient achieve expected outcomes. Within which
American Nurses Association standard is the nurse practicing?

1. Planning

2. Assessment

3. Diagnosis

4. Implementation

Correct Answer: 1

Rationale 1: The American Nurses Association Standards of Practice follow the nursing process. The nurse who
prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within the
standard of planning.

Rationale 2: Assessment activities include data collection.

Rationale 3: Diagnosis activities include analyzing data to determine issues.

Rationale 4: Implementation activities include implementing the identified plan, coordinating care delivery, and
employing strategies to promote health and a safe environment.

Global Rationale: The American Nurses Association Standards of Practice follow the nursing process. The nurse
who prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within the
standard of planning. Assessment activities include data collection. Diagnosis activities include analyzing data to
determine issues. Implementation activities include implementing the identified plan, coordinating care delivery,
and employing strategies to promote health and a safe environment.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human
experience
AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding
of human growth and development, pathophysiology, pharmacology, medical management and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health
assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Page Number: 10

Question 8
Type: MCSA

A patient with a terminal illness is concerned about pain control. If the International Council of Nurses Code of
Ethics for Nurses is followed, what should the nurse plan for the patient?

1. Measures to alleviate suffering

2. Modified activities of daily living

3. Enforcement of strict bed rest

4. Dietary interventions to maximize strength

Correct Answer: 1

Rationale 1: The philosophical basis for the International Council of Nurses Code of Ethics for Nurses is the
responsibility to promote health, prevent illness, and alleviate suffering. The nurse should plan measures to
alleviate the patient’s suffering.

Rationale 2: Modified activities of daily living may not affect pain control.

Rationale 3: Enforcement of strict bed rest may not affect pain control.

Rationale 4: Dietary interventions to maximize strength may not affect pain control.

Global Rationale: The philosophical basis for the International Council of Nurses Code of Ethics for Nurses is
the responsibility to promote health, prevent illness, and alleviate suffering. The nurse should plan measures to
alleviate the patient’s suffering. Modified activities of daily living, enforcement of strict bed rest, and dietary
interventions to maximize strength may not affect pain control.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values,
preferences and expressed needs
AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and
palliative care issues, such as symptom management, support of rituals, and respect for patient and family
preferences
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome: 3.4.3. Critique interventions appropriate for the client with cancer.
Page Number: 9
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Question 9
Type: MCSA

A patient is angry after waiting over an hour for pain medication. What should the nurse respond to the patient
that demonstrates critical thinking?

1. “I understand your anger and am sorry for the delay. I have your pain medication now.”

2. “I had other patients who needed my attention first, so I did a few things before getting the pain medication.”

3. “I needed to find out what your medication is and if you can have more when you asked.”

4. “It seems that you always ask for pain medication when I am trying to do other things.”

Correct Answer: 1

Rationale 1: Critical thinking is evident when the nurse challenges assumptions, overtly identifies and
acknowledges the values and beliefs he/she brings to the situation, considers the influence of context, generates
possible explanations, and deliberately maintains healthy skepticism. For the patient who is angry, this statement
demonstrates empathy and critical thinking.

Rationale 2: This statement is not an example of critical thinking and would be an inappropriate response.

Rationale 3: This statement is not an example of critical thinking and would be an inappropriate response.

Rationale 4: This statement is not an example of critical thinking and would be an inappropriate response.

Global Rationale: Critical thinking is evident when the nurse challenges assumptions, overtly identifies and
acknowledges the values and beliefs he/she brings to the situation, considers the influence of context, generates
possible explanations, and deliberately maintains healthy skepticism. As the patient is angry, the statement that
demonstrates empathy and critical thinking is “I understand your anger and am sorry for the delay. I have your
pain medication now.” The other choices are not examples of critical thinking and would be inappropriate
responses.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values,
preferences and expressed needs
AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and
palliative care issues, such as symptom management, support of rituals, and respect for patient and family
preferences
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 4

Question 10
Type: MCSA

The nurse is reviewing data collected from a patient during an assessment. Which activity demonstrates that the
nurse is using divergent thinking when analyzing this data?

1. The nurse identifies abnormal data for further analyzing.

2. The nurse focuses on normal data to rule out health problems.

3. The nurse discriminates between facts and guesses.

4. The nurse thinks about the information to determine solutions.

Correct Answer: 1

Rationale 1: Divergent thinking, a critical-thinking skill, is the ability to weigh the importance of information.
The nurse should sort out the data that are relevant from data that are irrelevant for the patient, remembering that
abnormal data are usually considered relevant.

Rationale 2: Normal data are helpful but may not change the care to provide to the patient. This is not divergent
thinking because it does not weigh the importance of the information.

Rationale 3: Discriminating between facts and guesses describes the critical-thinking skill of reasoning.

Rationale 4: Thinking about the information to determine solutions describes the critical-thinking skill of
reflection.

Global Rationale: Divergent thinking, a critical-thinking skill, is the ability to weigh the importance of
information. The nurse should sort out the data that are relevant from data that are irrelevant for the patient.
Abnormal data are usually considered relevant; normal data are helpful but may not change the care to provide to
the patient. Discriminating between facts and guesses describes the critical-thinking skill of reasoning. Thinking
about the information to determine solutions describes the critical-thinking skill of reflection.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 4

Question 11
Type: MCSA

The nurse is identifying nursing diagnoses appropriate for a patient’s plan of care. What should the nurse use to
determine these diagnoses?

1. Diagnostic reasoning

2. Communication techniques

3. Identified outcome criteria

4. Established priorities

Correct Answer: 1

Rationale 1: Making a diagnosis is a complex process, and the nurse uses diagnostic reasoning to choose nursing
diagnoses that best define the individual patient’s health problems. Diagnostic reasoning is a form of clinical
judgment used to make decisions about which label, or diagnosis, best describes the patterns of data. Steps in the
process include identifying significant cues, clustering the cues and identifying gaps, drawing conclusions about
the present health status, and determining etiologies and categorizing problems.

Rationale 2: Communication techniques would be needed when conducting the patient assessment.

Rationale 3: Identification of outcome criteria is a part of the planning phase of the nursing process.

Rationale 4: Priorities are established during the implementation phase of the nursing process.

Global Rationale: Making a diagnosis is a complex process, and the nurse uses diagnostic reasoning to choose
nursing diagnoses that best define the individual patient’s health problems. Diagnostic reasoning is a form of
clinical judgment used to make decisions about which label, or diagnosis, best describes the patterns of data. Steps
in the process include identifying significant cues, clustering the cues and identifying gaps, drawing conclusions
about the present health status, and determining etiologies and categorizing problems. Communication techniques
would be needed when conducting the patient assessment. Identification of outcome criteria is a part of the
planning phase of the nursing process. Priorities are established during the implementation phase of the nursing
process.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 6

Question 12
Type: MCSA

The nurse plans and implements care for a patient based on nursing knowledge and skills. In which role is the
nurse functioning?

1. Caregiver

2. Advocate

3. Educator

4. Leader

Correct Answer: 1

Rationale 1: The caregiver role for the nurse today is both independent and collaborative. Nurses independently
make assessments and plan and implement patient care based on nursing knowledge and skills.

Rationale 2: The nurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and
free choice.

Rationale 3: The nurse functioning in the role of educator nurse assesses learning needs, plans and implements
teaching methods to meet those needs, and evaluates the effectiveness of the teaching.

Rationale 4: The nurse functioning in the role of leader directs, delegates, and coordinates nursing activities.

Global Rationale: The caregiver role for the nurse today is both independent and collaborative. Nurses
independently make assessments and plan and implement patient care based on nursing knowledge and skills. The
nurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and free choice. The
nurse functioning in the role of educator nurse assesses learning needs, plans and implements teaching methods to
meet those needs, and evaluates the effectiveness of the teaching. The nurse functioning in the role of leader
directs, delegates, and coordinates nursing activities.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care
team
AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills
to deliver evidence-based, patient-centered care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 11

Question 13
Type: MCSA

A patient has questions about a required surgical procedure. When performing as a patient advocate, what should
the nurse do?

1. Contact the healthcare provider and ask that the procedure be explained to the patient.

2. Explain the procedure to the patient.

3. Document that the patient does not understand the proposed surgical procedure.

4. Instruct the patient in alternatives to the surgical procedure.

Correct Answer: 1

Rationale 1: The nurse as patient advocate actively promotes the patient’s rights to autonomy and free choice.
The nurse should protect the patient’s right to self-determination about the surgical procedure.

Rationale 2: The nurse should not explain the procedure to the patient. This is not patient advocacy.

Rationale 3: The nurse should not do anything beyond documenting the patient’s lack of understanding about the
procedure.

Rationale 4: The nurse should not provide alternatives to the surgical procedure.

Global Rationale: The nurse as patient advocate actively promotes the patient’s rights to autonomy and free
choice. The nurse should protect the patient’s right to self-determination about the surgical procedure. The nurse
should not explain the procedure to the patient. The nurse should not do anything beyond documenting the
patient’s lack of understanding about the procedure. The nurse should not provide alternatives to the surgical
procedure.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care

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QSEN Competencies: I.B.2. Communicate patient values, preferences and expressed needs to other members of
health care team
AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills
to deliver evidence-based, patient-centered care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13

Question 14
Type: MCSA

The nurse teaches a patient newly diagnosed with type 2 diabetes mellitus about the importance of an annual
dilated-retina eye examination and annual urine tests to measure protein levels. Within which role is the nurse
functioning?

1. Educator

2. Researcher

3. Advocate

4. Leader

Correct Answer: 1

Rationale 1: The nurse is functioning as an educator by instructing the patient on annual tests to maintain health.

Rationale 2: As a researcher, the nurse would have a goal to improve the care nurses provide to patients.

Rationale 3: As an advocate, the nurse actively promotes the patient’s rights to autonomy and free choice.

Rationale 4: As a leader, the nurse manages time, people, and resources by delegating, directing, and
coordinating nursing activities.

Global Rationale: The nurse is functioning as an educator by instructing the patient on annual tests to maintain
health. As a researcher, the nurse would have a goal to improve the care nurses provide to patients. As an
advocate, the nurse actively promotes the patient’s rights to autonomy and free choice. As a leader, the nurse
manages time, people, and resources by delegating, directing, and coordinating nursing activities.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care

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AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage,
age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in
their care
NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome: 10.5.4. Utilize the nursing process in care of client.
Page Number: 12

Question 15
Type: MCMA

The nurse is providing care within the primary nursing delivery model. Which leadership activities should the
nurse perform within this model?

Standard Text: Select all that apply.

1. Communicate with patients, families, and other care providers.

2. Serve as the team leader by making assignments and being responsible for all care provided.

3. Make referrals and manage the quality of care to include timeliness and cost.

4. Manage a caseload of patients and the health team members providing care to the patients.

5. Create patient discharge plans.

Correct Answer: 1, 5

Rationale 1: When providing care to patients within the primary nursing care delivery model, leadership activities
of the nurse include communicating with patients, families, and other care providers.

Rationale 2: In the team nursing care delivery model, leadership activities of the nurse include serving as the
team leader, making assignments, and being responsible for all care provided.

Rationale 3: In the transitional care coordination model, leadership activities of the nurse include making
referrals and managing the quality of care to include timeliness and cost.

Rationale 4: In the transitional care coordination model, leadership activities of the nurse include managing a
caseload of patients and the health team members providing care to the patients.

Rationale 5: When providing care to patients within the primary nursing care delivery model, leadership
activities of the nurse include creating discharge plans.

Global Rationale: When providing care to patients within the primary nursing care delivery model, leadership
activities of the nurse include communicating with patients, families, and other care providers, and planning the
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discharge of the patients. In the team nursing care delivery model, leadership activities of the nurse include
serving as the team leader, making assignments, and being responsible for all care provider. In the transitional
care coordination model, leadership activities of the nurse include making referrals, managing the quality of care
to include timeliness and cost, managing a caseload of patients, and managing the health team members providing
care to the patients.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care
AACN Essentials Competencies: I.4. Use written, verbal, non-verbal and emerging technology methods to
communicate effectively
NLN Competencies: Quality and Safety; Practice; Communicate effectively with different individuals (team
members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among
providers and across transitions in care.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13

Question 16
Type: MCSA

The nurse is using a specific process to plan smoking cessation activities for a patient. What is this nurse most
likely using to plan the care for this patient?

1. Nursing process

2. Critical pathways

3. Evidence-based practice

4. Variance analysis

Correct Answer: 1

Rationale 1: The nursing process is a series of critical-thinking and clinical reasoning activities that nurses use to
provide care to patients. The purpose of care may be to promote wellness, restore health, or facilitate coping with
a disability or death.

Rationale 2: Critical pathways are used primarily to manage disease conditions.

Rationale 3: Evidence-based practice is used primarily to manage disease conditions.

Rationale 4: Variance analyzing implies the use of statistics-based research.

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Global Rationale: The nursing process is a series of critical-thinking and clinical reasoning activities that nurses
use to provide care to patients. The purpose of care may be to promote wellness, restore health, or facilitate
coping with a disability or death. Critical pathways and evidence-based practice are used primarily to manage
disease conditions. Variance analyzing implies the use of statistics-based research.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 5

Question 17
Type: MCSA

The nurse stops to think about a previous patient care situation before providing care to a current patient. What
type of thinking is this nurse performing?

1. Reflective

2. Divergent

3. Systematic

4. Creative

Correct Answer: 1

Rationale 1: Reflective thinking involves two kinds of thinking. Reflecting-in-action occurs while a situation is
being addressed. Reflecting-on-action is deliberate, occurs after an event, and creates embodied knowledge and
skillfulness that will influence what the nurse perceives as salient when confronted with similar patient situations
in the future.

Rationale 2: Divergent thinking is the ability to weigh the importance of information.

Rationale 3: Systematic thinking involves collecting, analyzing, and organizing information in a methodical
manner that supports development of pattern recognition.

Rationale 4: Creative thinking involves clinical imagination that integrates science, skilled know-how, and
practical knowledge to develop unique solutions to individual patient needs.

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Global Rationale: Reflective thinking involves two kinds of thinking. Reflecting-in-action occurs while a
situation is being addressed. Reflecting-on-action is deliberate, occurs after an event, and creates embodied
knowledge and skillfulness that will influence what the nurse perceives as salient when confronted with similar
patient situations in the future. Divergent thinking is the ability to weigh the importance of information.
Systematic thinking involves collecting, analyzing, and organizing information in a methodical manner that
supports development of pattern recognition. Creative thinking involves clinical imagination that integrates
science, skilled know-how, and practical knowledge to develop unique solutions to individual patient needs.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 4

Question 18
Type: MCSA

A nurse working on a quality improvement study wants to evaluate a patient care process. What should the nurse
use to evaluate this process?

1. Nursing process

2. Critical pathway

3. Variance analysis

4. Evidence-based practice

Correct Answer: 1

Rationale 1: The nursing process can serve as a framework for the evaluation of quality care.

Rationale 2: The use of critical pathways would not provide the best, recommended means to evaluate a patient
care process.

Rationale 3: The use of variance analysis would not provide the best, recommended means to evaluate a patient
care process.

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Rationale 4: The use of evidence-based practice would not provide the best, recommended means to evaluate a
patient care process.

Global Rationale: The nursing process can serve as a framework for the evaluation of quality care. The use of
critical pathways, variance analysis, and evidence-based practice would not provide the best, recommended means
to evaluate a patient care process.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: IV.A.1. Describe strategies for learning about the outcomes of care in the setting in which
one is engaged in clinical practice
AACN Essentials Competencies: II.1.Apply leadership concepts, skills and decision making in the provision of
high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery in a
variety of settings
NLN Competencies: Knowledge and Science; Knowledge; Relationships between knowledge/science and quality
and safe patient care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 5

Question 19
Type: MCSA

The nurse is reviewing the outcome of care that was provided to a patient. Which nursing process step is the nurse
implementing?

1. Evaluation

2. Assessment

3. Implementation

4. Planning

Correct Answer: 1

Rationale 1: The evaluation step allows the nurse to determine whether the plan was effective and whether to
continue, revise, or terminate the plan. The outcome criteria that were established during the planning step
provide the basis for evaluation.

Rationale 2: During the assessment phase, the nurse is actively collecting data.

Rationale 3: Implementation is the phase of the nursing process during which the nurse performs interventions.

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Rationale 4: Determining the needs of the patient and devising a plan of action take place during the planning
phase.

Global Rationale: The evaluation step allows the nurse to determine whether the plan was effective and whether
to continue, revise, or terminate the plan. The outcome criteria that were established during the planning step
provide the basis for evaluation. During the assessment phase, the nurse is actively collecting data.
Implementation is the phase of the nursing process during which the nurse performs interventions. Determining
the needs of the patient and devising a plan of action take place during the planning phase.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.C.10. Value active partnership with patients or designated surrogates in planning,
implementation, and evaluation of care
AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of
psychobiological interventions
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 9

Question 20
Type: MCSA

A patient says, “I have pain in my leg when I stand too long.” As which type of data should the nurse categorize
this information?

1. Subjective

2. Evaluative

3. Qualitative

4. Objective

Correct Answer: 1

Rationale 1: Information that is perceived only by the person experiencing it is subjective data.

Rationale 2: Evaluative data is used to assess responses to care.

Rationale 3: Qualitative data refers to the presence or absence of a factor.

Rationale 4: Objective data can be measured by someone or something other than the patient.

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Global Rationale: Information that is perceived only by the person experiencing it is subjective data. Evaluative
data is used to assess responses to care. Qualitative data refers to the presence or absence of a factor. Objective
data can be measured by someone or something other than the patient.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.1. Elicit patient values, preferences and expressed needs as part of clinical interview,
implementation of care plan and evaluation of care
AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using
developmentally and culturally appropriate approaches
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health
assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome: Page Number: 6

Question 21
Type: MCSA

While providing care, the nurse stops to assess a new patient problem. What type of assessment is the nurse
conducting?

1. Focused

2. Initial

3. Objective

4. Subjective

Correct Answer: 1

Rationale 1: Focused assessments are ongoing and continuous, occurring whenever the nurse interacts with the
patient. In a focused assessment, data are gathered about an identified or potential problem and are used to
evaluate nursing actions and make decisions about whether to continue or change interventions to meet outcomes.
Focused assessments enable the nurse to identify responses to a disease process or treatment modality not present
during the initial assessment, and to identify new problems.

Rationale 2: The initial assessment refers to the first interaction.

Rationale 3: Subjective assessment is not indicated in this scenario.

Rationale 4: Objective assessment is not indicated in this scenario.

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Global Rationale: Focused assessments are ongoing and continuous, occurring whenever the nurse interacts with
the patient. In a focused assessment, data are gathered about an identified or potential problem and are used to
evaluate nursing actions and make decisions about whether to continue or change interventions to meet outcomes.
Focused assessments enable the nurse to identify responses to a disease process or treatment modality not present
during the initial assessment, and to identify new problems. The initial assessment refers to the first interaction.
Subjective and objective assessments are not indicated in this scenario.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.1. Elicit patient values, preferences and expressed needs as part of clinical interview,
implementation of care plan and evaluation of care
AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using
developmentally and culturally appropriate approaches
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health
assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 6

Question 22
Type: MCSA

At the completion of an assessment, the nurse chooses a nursing diagnosis that best defines the patient’s health
problems. Which type of clinical judgment should the nurse use at this time?

1. Diagnostic reasoning

2. Evidence-based practice

3. Critical pathway

4. Nursing process

Correct Answer: 1

Rationale 1: Diagnostic reasoning is a form of clinical judgment used to make decisions about which diagnostic
label best describes the patterns of patient data.

Rationale 2: Evidence-based practice refers to the implementation of care initiatives that have been supported by
research.

Rationale 3: A critical pathway is a health care plan developed to provide care with a multidisciplinary, managed
action focus.

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Rationale 4: The nursing process is a series of critical thinking and clinical reasoning activities nurses use as they
provide care to patients.

Global Rationale: Diagnostic reasoning is a form of clinical judgment used to make decisions about which
diagnostic label best describes the patterns of patient data. Evidence-based practice refers to the implementation
of care initiatives that have been supported by research. A critical pathway is a healthcare plan developed to
provide care with a multidisciplinary, managed action focus. The nursing process is a series of critical thinking
and clinical reasoning activities nurses use as they provide care to patients.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 6

Question 23
Type: MCSA

The nurse is creating outcome criteria for identified nursing diagnoses for a patient. What characteristics should
the nurse include when creating the criteria?

1. Patient-specific, time-specific, and measurable

2. Constructed as nursing goals

3. Structured as statements

4. Focus on psychomotor actions

Correct Answer: 1

Rationale 1: Outcome criteria for nursing diagnoses are patient-centered, time-specific, and measurable. They are
classified into three domains: cognitive, affective, and psychomotor.

Rationale 2: The focus of the outcome criteria is the patient, not the nurse.

Rationale 3: While the outcome criteria are often written as statements, this option does not encompass all of the
criteria that are to be included.

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Rationale 4: Outcome criteria are not limited to psychomotor skills; they may also be cognitive or affective.

Global Rationale: Outcome criteria for nursing diagnoses are patient-centered, time-specific, and measurable.
They are classified into three domains: cognitive, affective, and psychomotor. The focus of the outcome criteria is
the patient, not the nurse. While the outcome criteria are often written as statements, this option does not
encompass all of the criteria that are to be included. Outcome criteria are not limited to psychomotor skills; they
may also be cognitive or affective.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.8. Describe the limits and boundaries of therapeutic patient-centered care
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Quality and Safety; Practice; Contribute to assessment of outcome achievement
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 7

Question 24
Type: MCSA

The nurse is implementing a plan of care for a patient. After providing care, what should the nurse do as the final
step in the process?

1. Document

2. Reassess the patient

3. Measure vital signs

4. Provide report to the charge nurse

Correct Answer: 1

Rationale 1: Documenting interventions is the final component of implementation as well as a legal requirement.

Rationale 2: Ongoing assessment of the patient is an essential component of implementation, but it is not the final
step.

Rationale 3: Measuring vital signs can be completed at any time and not necessarily at the end of implementing
the plan of care.

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Rationale 4: Providing report is an ongoing process and is not necessarily completed after implementing the plan
of care.

Global Rationale: Documenting interventions is the final component of implementation as well as a legal
requirement. Ongoing assessment of the patient is an essential component of implementation, but it is not the final
step. Measuring vital signs can be completed at any time and not necessarily at the end of implementing the plan
of care. Providing report is an ongoing process and is not necessarily completed after implementing the plan of
care.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: VI.B.4. Document and plan patient care in an electronic health record
AACN Essentials Competencies: IV.4. Understand the use of CIS (clinical information systems) systems to
document interventions related to achieving nurse sensitive outcomes
NLN Competencies: Knowledge and Science; Practice; Use Databases for practice, administrative, education,
and/or research purposes; document via electronic health records; use software applications related to nursing
practice
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 9

Question 25
Type: MCSA

A patient care issue has been raised about the actions taken by a nurse who provided care to a patient whose
healthcare decisions were considered controversial. The unit’s nurse manager is concerned that care was not
appropriately provided. What should be consulted to protect the patient and to evaluate the care in question?

1. Nursing Code of Ethics

2. Hospital quality improvement guidelines

3. Nurse Practice Act

4. Critical pathway

Correct Answer: 1

Rationale 1: An established code of ethics is one criterion that defines a profession. Ethics are principles of
conduct. Codes of ethics for nurses provide a frame of reference for ideal nursing behaviors that are congruent
with the principles expressed in the Code for Nurses.

Rationale 2: Quality improvement uses data to monitor the outcomes of care and the processes used to deliver
that care.

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Rationale 3: The Nurse Practice Act provides the standards for an individual state’s stance on the nurse’s scope
of practice.

Rationale 4: A critical pathway is a healthcare plan developed to provide care with a multidisciplinary, managed
action focus.

Global Rationale: An established code of ethics is one criterion that defines a profession. Ethics are principles of
conduct. Codes of ethics for nurses provide a frame of reference for ideal nursing behaviors that are congruent
with the principles expressed in the Code for Nurses. Quality improvement uses data to monitor the outcomes of
care and the processes used to deliver that care. The Nurse Practice Act provides the standards for an individual
state’s stance on the nurse’s scope of practice. A critical pathway is a healthcare plan developed to provide care
with a multidisciplinary, managed action focus.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care
AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal or unethical care practices
NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional
standards
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
Page Number: 9

Question 26
Type: MCSA

The nurse is preparing a patient to go home. Which skill should the nurse use when preparing this patient?

1. Familiarity with adult learning principles

2. Ability to follow written orders

3. Ability to use critical thinking

4. Ability to support patient decision making

Correct Answer: 1

Rationale 1: The nurse will function as an educator when preparing a patient for discharge. To do this adequately,
the nurse will need to have some level of familiarity with adult learning principles to provide effective patient
education and evaluate the outcome.

Rationale 2: Following written orders is considered a basic caregiver skill.

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Rationale 3: Using critical thinking would be considered a basic caregiver skill.

Rationale 4: The ability to support patient decision making relates to the role of patient advocate.

Global Rationale: The nurse will function as an educator when preparing a patient for discharge. To do this
adequately, the nurse will need to have some level of familiarity with adult learning principles to provide effective
patient education and evaluate the outcome. Following written orders and using critical thinking would be
considered basic caregiver skills. The ability to support patient decision making relates to the role of patient
advocate.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human
experience
AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage,
age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in
their care
NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13

Question 27
Type: MCSA

The nurse is preparing to provide patient care information to a group of unlicensed assistive personnel. Which
type of care delivery system is this nurse most likely using to provide patient care?

1. Team nursing

2. Functional nursing

3. Primary nursing

4. Case management

Correct Answer: 1

Rationale 1: Team nursing is practiced by teams of healthcare providers with various levels of education,
including unlicensed assistive personnel. Team members work together and provide the care for which they are
individually trained.

Rationale 2: Functional nursing is not a recognized term.

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Rationale 3: In primary nursing, total nursing care is provided by the assigned nurse.

Rationale 4: The focus of case management is meeting the needs and care of a group of patients, with concurrent
goals of maximized outcomes and cost containment.

Global Rationale: Team nursing is practiced by teams of healthcare providers with various levels of education,
including unlicensed assistive personnel. Team members work together and provide the care for which they are
individually trained. Functional nursing is not a recognized term. In primary nursing, total nursing care is
provided by the assigned nurse. The focus of case management is meeting the needs and care of a group of
patients, with concurrent goals of maximized outcomes and cost containment.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation
AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession
with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure
requirements)
NLN Competencies: Relationship Centered Care; Knowledge; Team building and team dynamics
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13

Question 28
Type: MCSA

A nurse has delegated the collection of vital signs, including blood pressure readings, to two unlicensed assistive
personnel. What is the nurse’s responsibility for the delegated care?

1. The nurse is accountable for the care that was delegated.

2. The nurse is not responsible for these vital signs.

3. The nurse is not accountable for these vital signs.

4. The nurse is responsible for re-measuring all the vital signs.

Correct Answer: 1

Rationale 1: When the nurse delegates nursing care activities to another person, that person is authorized to act in
the place of the nurse, while the nurse retains accountability for the activities performed.

Rationale 2: The nurse retains responsibility/accountability for the vital signs.

Rationale 3: The nurse is accountable for reviewing the data collected and ensuring it is done appropriately.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 4: The purpose of delegation is to share tasks appropriately, not to increase the workload of the primary
nurse.

Global Rationale: When the nurse delegates nursing care activities to another person, that person is authorized to
act in the place of the nurse, while the nurse retains accountability for the activities performed. The nurse retains
responsibility/accountability for the vital signs. The nurse is accountable for reviewing the data collected and
ensuring it is done appropriately. The purpose of delegation is to share tasks appropriately, not to increase the
workload of the primary nurse.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation
AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession
with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure
requirements)
NLN Competencies: Relationship Centered Care; Knowledge; Team building and team dynamics
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 14

Question 29
Type: MCSA

Quality assurance chart audits provide nurses with information that impacts the future outcomes of patient care.
What should the nurses do with this information?

1. Create an action plan to address any negative findings.

2. Share it with the hospital administrator.

3. Submit it to the agency’s accrediting body.

4. Place it in a file to compare with the next set of audits.

Correct Answer: 1

Rationale 1: The results of quality assurance audits can be used to develop a plan of action to resolve differences
or issues with patient care. Nurses are expected to use the information if it will have a positive impact on the
nursing practice.

Rationale 2: There is no real purpose to sharing the results of a quality assurance audit with the hospital
administrator.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 3: While the accrediting body of an institution may encourage quality improvement activities, there is
no reason to provide the chart audit results.

Rationale 4: Nurses are expected to use the information if it will have a positive impact on the nursing practice.

Global Rationale: The results of quality assurance audits can be used to develop a plan of action to resolve
differences or issues with patient care. There is no real purpose to sharing the results of a quality assurance audit
with the hospital administrator. While the accrediting body of an institution may encourage quality improvement
activities, there is no reason to provide the chart audit results. Nurses are expected to use the information if it will
have a positive impact on the nursing practice.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: IV.B. 5. Use quality measures to understand performance
AACN Essentials Competencies: II. 1. Apply leadership concepts, skills and decision making in the provision of
high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery in a
variety of settings
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1. Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information
technology.
MNL Learning Outcome:
Page Number: 4

Question 30
Type: MCSA

A graduate nurse attends a seminar regarding the role of the nurse as a patient advocate. Which statement by the
graduate nurse indicates the need for further education?

1. “Patient advocates have the authority to make decisions for the patient.”

2. “Being a patient advocate entails making efforts to improve patient outcomes.”

3. “Providing education to the patient and family is a key way to be a positive patient advocate.”

4. “Communicating patient needs to the members of the healthcare team is a role of the patient advocate.”

Correct Answer: 1

Rationale 1: The nurse who serves as a patient advocate may assist and support the patient in decision making.
The nurse cannot make decisions for the patient.

Rationale 2: This is an element of being a successful patient advocate.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 3: This is an element of being a successful patient advocate.

Rationale 4: This is an element of being a successful patient advocate.

Global Rationale: The nurse who serves as a patient advocate may assist and support the patient in decision
making. The nurse cannot make decisions for the patient. The remaining answer choices are elements of being a
successful patient advocate.

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.2. Communicate patient values, preferences and expressed needs to other members of
health care team
AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills
to deliver evidence-based, patient-centered care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13

Question 31
Type: MCMA

The nurse is assessing a patient with pain in the lower back. Which questions or results indicate the nurse is using
divergent thinking during the assessment process?

Standard Text: Select all that apply.

1. “Tell me about your dietary practices.”

2. “Can you tell me on a scale of 1 to 10, with 10 being the worst, how you would rate your pain now?”

3. The nurse notes a cluster of blisters on the patient’s scapula.

4. “When was the last time you had a physical?”

5. “Does your eyesight affect your ability to see the insulin you are taking?”

Correct Answer: 2, 3, 5

Rationale 1: Normal data are helpful but may not change the care the nurse provides.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Rationale 2: Divergent thinking is the ability to weigh the importance of information. When collecting data from
a patient, the nurse can sort out the data that are relevant for care from the data that are not relevant.

Rationale 3: Divergent thinking is the ability to weigh the importance of information. When collecting data from
a patient, the nurse can sort out the data that are relevant for care from the data that are not relevant.

Rationale 4: Normal data are helpful but may not change the care the nurse provides.

Rationale 5: Divergent thinking is the ability to weigh the importance of information. When collecting data from
a patient, the nurse can sort out the data that are relevant for care from the data that are not relevant.

Global Rationale: Divergent thinking is the ability to weigh the importance of information. When collecting data
from a patient, the nurse can sort out the data that are relevant for care from the data that are not relevant. Normal
data are helpful but may not change the care the nurse provides.

Cognitive Level: Applying

Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes
AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and
patient preferences in planning, implementing, and evaluating outcomes of care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome:
Page Number: 4

Question 32
Type: SEQ

Arrange in order the steps the nurse should take in a focused assessment for a patient with type 2 diabetes
mellitus.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Nurse notes patient is reluctant to draw up insulin in syringe.

Choice 2. Nurse assesses what the patient already knows.

Choice 3. Nurse has patient practice drawing up insulin.

Choice 4. Nurse calls in diabetic educator.

Choice 5. Nurse notes patient is not aware of differences between hypo- and hyperglycemia.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Correct Answer: 2, 5, 1, 3, 4

Rationale 1:

Rationale 2:

Rationale 3:

Rationale 4:

Rationale 5:

Global Rationale: Focused assessments are ongoing and continuous. Data are used to evaluate nursing actions
and make decisions about whether to continue or change interventions to meet outcomes. Assessments also
provide structure for documenting nursing care, enable responses to a disease process or treatment, and identify
new problems. For this situation, the nurse should follow the nursing process and begin by assessing what the
patient already knows. From this, the nurse would note that the patient does not know the difference between
hypo- and hyperglycemia. The nurse would also observe that the patient is reluctant to draw up insulin and would
address this reluctance by having the patient practice. Finally the nurse would consult with a diabetic educator to
assist with the patient’s teaching.

Cognitive Level: Applying

Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
QSEN Competencies: I.B.1. Elicit patient values, preferences and expressed needs as part of clinical interview,
implementation of care plan and evaluation of care
AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological,
spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using
developmentally and culturally appropriate approaches
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health
assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3. Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using
the nursing process in patient care.
MNL Learning Outcome: 10.5.4. Utilize the nursing process in care of client.
Page Number: 6

Question 33
Type: MCSA

The director of nursing is reviewing situations that require attention. Which situation is an ethical dilemma that
might need to be studied by the hospital Ethics Committee?

1. A 20-year-old male patient with an opportunistic disease is HIV positive and does not want to share this
information with his sexual partners.

2. The nurse–patient ratio is 5:1 on a medical-surgical care area.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
3. A nurse inexperienced with electrocardiogram interpretation was assigned to the telemetry unit to provide care.

4. Nursing staff provide medication to patients after doses are dropped on the floor.

Correct Answer: 1

Rationale 1: A dilemma is a choice between two unpleasant, ethically troubling alternatives. Nurses who provide
medical-surgical nursing care face dilemmas almost daily. Many commonly experienced dilemmas involve
confidentiality, patient rights, and issues of dying and death. Nurses respect the right to confidentiality of patient
information found in the patient’s record or secured during interviews. An individual’s right to privacy and
confidentiality creates a dilemma when it conflicts with the nurse’s right to information that may affect personal
safety. The law in most states mandates that HIV test results can be given to another person only with the
patient’s written consent. Many healthcare providers believe that this law violates their own right to personal
safety.

Rationale 2: This situation is not a dilemma but may violate standards of care or standards of practice.

Rationale 3: This situation is not a dilemma but may violate standards of care or standards of practice.

Rationale 4: This situation is not a dilemma but may violate standards of care, codes of ethics, or standards of
practice.

Global Rationale: A dilemma is a choice between two unpleasant, ethically troubling alternatives. Nurses who
provide medical-surgical nursing care face dilemmas almost daily. Many commonly experienced dilemmas
involve confidentiality, patient rights, and issues of dying and death. Nurses respect the right to confidentiality of
patient information found in the patient’s record or secured during interviews. An individual’s right to privacy and
confidentiality creates a dilemma when it conflicts with the nurse’s right to information that may affect personal
safety. The law in most states mandates that HIV test results can be given to another person only with the
patient’s written consent. Many healthcare providers believe that this law violates their own right to personal
safety. The other situations are not dilemmas but may violate standards of care, codes of ethics, or standards of
practice.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity
Client Need Sub:
QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care
AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal or unethical care practices
NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional
standards
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
Page Number: 11

Question 34
Type: MCMA
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
The nurse is approached by a patient who offers to provide the nurse with tickets to a sporting event in exchange
for free home care for 1 week. The nurse accepts this offer. Which standards did the nurse violate?

Standard Text: Select all that apply.

1. HIPAA

2. ANA standards

3. Professional boundaries

4. State nurse practice acts

5. Standards pertinent to specific hospital protocols

Correct Answer: 3, 4

Rationale 1: HIPAA involves violations of patient confidentiality.

Rationale 2: A violation of ethics in the ANA Standards of Care would not apply here.

Rationale 3: Professional boundaries are the borders between the vulnerability of the patient and the power of the
nurse. It is vital that nurses recognize this relationship and establish boundaries to safely and effectively meet the
patient’s needs. Confusion between the needs of the nurse and those of the patient can result in boundary
violations.

Rationale 4: Professional boundaries are outlined in individual state nurse practice acts.

Rationale 5: Hospital protocols are not identified in the question; however, the nurse’s action violates a
professional boundary.

Global Rationale: Professional boundaries are the borders between the vulnerability of the patient and the power
of the nurse. It is vital that nurses recognize this relationship and establish boundaries to safely and effectively
meet the patient’s needs. Confusion between the needs of the nurse and those of the patient can result in boundary
violations. HIPAA addresses confidentiality. ANA standards address ethics and codes of conduct. Hospital
protocols are not a part of this question.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity
Client Need Sub:
QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care
AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal
conduct
NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional
standards
Nursing/Integrated Concepts: Nursing Process: Evaluation
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
Page Number: 11

Question 35
Type: MCSA

A seasoned nurse does not want to assist nursing students during clinical rotations and often obstructs the
students’ learning process. Which standard is this nurse violating?

1. ICN Code of Ethics

2. ANA Standards of Practice

3. ANA Code of Ethics

4. State practice acts

Correct Answer: 2

Rationale 1: The ICN Code of Ethics for Nurses helps guide nurses in setting priorities, making judgments, and
taking action when they face ethical dilemmas in clinical practice.

Rationale 2: The nurse is violating the standards of leadership and collaboration by refusing to assist the students
during the learning process.

Rationale 3: The nurse is not violating the Code of Ethics.

Rationale 4: The nurse is not violating the state nurse practice act.

Global Rationale: The nurse is violating the standards of leadership and collaboration when refusing to assist the
students during the learning process. The nurse is not violating a Code of Ethics or the state nurse practice act.

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: II.C.6. Value teamwork and the relationships upon which it is based
AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal
conduct
NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional
standards
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 4. Explain the importance of nursing and interprofessional codes of ethics and standards of
practice as guidelines for clinical nursing practice.
MNL Learning Outcome:
Page Number: 10
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Question 36
Type: MCSA

The nurse attends interprofessional meetings to discuss the plan of care for a trauma patient who has been
transferred to the medical-surgical unit. In what role is this nurse functioning?

1. Caregiver

2. Team leader

3. Delegate

4. Advocate

Correct Answer: 4

Rationale 1: The caregiver works independently and collaboratively with the patient.

Rationale 2: Team leaders are nurses who are participating in roles of leadership in that they manage time,
people, resources, and the environment to ensure that staff is able to provide the proper care.

Rationale 3: Delegates are nurses who are responsible for completing care as assigned.

Rationale 4: The nurse as advocate actively promotes the patient’s rights to autonomy and free choice. The nurse
will communicate with other healthcare team members and assist and support patient decision making.

Global Rationale: The nurse as advocate actively promotes the patient’s rights to autonomy and free choice. The
nurse will communicate with other healthcare team members and assist and support patient decision making. The
caregiver works independently and collaboratively with the patient. Team leaders are nurses who are participating
in roles of leadership in that they manage time, people, resources, and the environment to ensure that staff is able
to provide the proper care. Delegates are nurses who are responsible for completing care as assigned.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B.2. Communicate patient values, preferences and expressed needs to other members of
health care team
AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills
to deliver evidence-based, patient-centered care
NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote
quality and improve practices
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 13
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
Question 37
Type: MCMA

The director of nursing is meeting with the hospital administrator to plan an initiative to improve the quality and
safety of patient care. After reviewing the Triple Aim approach, which actions should the director recommend?

Standard Text: Select all that apply.

1. Improve the patient care experience.

2. Improve the health of populations.

3. Reduce the per capita costs of health care.

4. Implement evidence-based practice.

5. Support nursing continuing education plans.

Correct Answer: 1, 2, 3

Rationale 1: The Triple Aim initiative was launched by The Institute of Health Improvement, which identified
approaches to improve models for healthcare. Improving the patient care experience is one of the three critical
objectives identified.

Rationale 2: The Triple Aim initiative was launched by The Institute of Health Improvement, which identified
approaches to improve models for healthcare. Improving the health of populations is one of the three critical
objectives identified.

Rationale 3: The Triple Aim initiative was launched by The Institute of Health Improvement, which identified
approaches to improve models for healthcare. Reducing the per capita costs of health care is one of the three
critical objectives identified.

Rationale 4: Implementing evidence-based practice is not an objective identified by the Triple Aim.

Rationale 5: Supporting nursing continuing education plans is not an objective identified by the Triple Aim.

Global Rationale: The Triple Aim initiative was launched by The Institute of Health Improvement, which
identified approaches to improve models for healthcare. This initiative identified three critical objectives: improve
the patient care experience, improve the health of populations, and reduce the per capita costs of health care.
Implementing evidence-based practice and supporting nursing continuing education plans are not objectives
identified by the Triple Aim.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank
Copyright 2015 by Pearson Education, Inc.
QSEN Competencies: IV.B.5. Use quality measures to understand performance
AACN Essentials Competencies: II.11. Employ principles of quality improvement, healthcare policy, and cost-
effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery
NLN Competencies: Quality and Safety; Knowledge; Factors that contribute to a systemwide safety culture; the
importance of reporting hazards and adverse events; the "just culture" approach to system improvement
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1.Describe the core competencies for healthcare professionals: patient-centered care,
interprofessional teams, evidence-based practice, quality improvement, safety, and health information
technology.
MNL Learning Outcome:
Page Number: 3

Question 38
Type: MCSA

The nurse would like to do a research project that focuses on vending machine choices that patients prefer. What
should the nurse question before proceeding with this research study?

1. Is the research valid?

2. Will this promote patient independence?

3. Is this a project that would add value to the hospital experience?

4. Does this research contribute to patient care?

Correct Answer: 4

Rationale 1: To be relevant, nursing research must have a goal to improve the care that nurses provide patients.
This means that all nurses must consider the researcher role to be integral to nursing practice. The research might
be valid; however, it does not improve patient care.

Rationale 2: To be relevant, nursing research must have a goal to improve the care that nurses provide patients.
This means that all nurses must consider the researcher role to be integral to nursing practice. The research might
promote patient independence but may not improve patient care.

Rationale 3: To be relevant, nursing research must have a goal to improve the care that nurses provide patients.
This means that all nurses must consider the researcher role to be integral to nursing practice. The research might
add value to the hospital experience but may not improve patient care.

Rationale 4: To be relevant, nursing research must have a goal to improve the care that nurses provide patients.
This means that all nurses must consider the researcher role to be integral to nursing practice.

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
Global Rationale: To be relevant, nursing research must have a goal to improve the care that nurses provide
patients. This means that all nurses must consider the researcher role to be integral to nursing practice. Research
that does not improve patient care is not appropriate.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities
AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research
process and models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science; Knowledge; Defining the relationships between research and
science building, and between research and EBP
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5. Explain the activities and characteristics of the nurse as caregiver, educator, advocate,
leader and manager, and researcher.
MNL Learning Outcome:
Page Number: 14

Question 39
Type: SEQ

The nurse is identifying nursing diagnoses for a patient’s care. In which order should the nurse complete this
process?

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Draw conclusions about the present health status.

Choice 2. Determine etiologies and categorize problems.

Choice 3. Cluster cues and identify data gaps.

Choice 4. Verify the problem or diagnoses.

Choice 5. Identify significant cues.

Correct Answer: 5, 3, 1, 2, 4

Rationale 1:

Rationale 2:

Rationale 3:

Rationale 4:

Rationale 5:

LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank

Copyright 2015 by Pearson Education, Inc.
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scattered grove. But this scene is viewed to more advantage from
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beautiful, viewed from the opposite shore, and had long charmed us
at a distance. Approaching them, we crossed another torrent,
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estates of the Duke of Norfolk and Mr. Hodgkinson, but the counties
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abruptly closing round the yellow harvest. The figures, together with
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Entering Glencoyn woods and sweeping the boldest bay of the

lake, while the water dashed with a strong surge upon the shore, we
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its shores exhibit, comprehending its two principal reaches, and
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The rude mountains above almost seemed to have fallen back from
the shore to admit this landscape within their hollow bosom, and
then, bending abruptly, appear, like Milton's Adam viewing the
sleeping Eve, to hang over it enamoured.

Lyulph's Tower is the only object of art, except the hamlet of

Watermillock, seen in the distant perspective, that appears in the
second bend of Ullswater; and this loses much of its effect from the
square uniformity of the structure, and the glaring green of its
painted window-cases. This is the longest reach of the lake.

Place-fell, which divides the two last bends, and was immediately
opposite to the point we were on, is of the boldest form. It projects
into the water, an enormous mass of gray crag, scarred with dark
hues; thence retiring a little it again bends forward in huge cliffs,
and finally starts up into a vast perpendicular face of rock. As a
single object, it is wonderfully grand; and, connected with the scene,
its effect is sublime. The lower rocks are called Silver-rays, and not
inaptly; for, when the sun shines upon them, their variegated sides
somewhat resemble in brightness the rays streaming beneath a
cloud.
 The last reach of Ullswater, which is on the right of this point,
expands into an oval, and its majestic surface is spotted with little
rocky islets, that would adorn a less sacred scene; here they are
prettinesses, that can scarcely be tolerated by the grandeur of its
character. The tremendous mountains, which scowl over the gorge
of Patterdale; the cliffs, massy, broken and overlooked by a
multitude of dark summits, with the grey walls of Swarth and
Martindale fells, that upheave themselves on the eastern shore, form
altogether one of the most grand and awful pictures on the lake;
yet, admirable and impressive as it is, as to solemnity and
astonishment, its effect with us was not equal to that of the more
alpine sketch, caught in distant perspective from the descent into
Gowbarrow-park.

In these views of Ullswater, sublimity and greatness are the

predominating characters, though beauty often glows upon the
western bank. The mountains are all bold, gloomy and severe. When
we saw them, the sky accorded well with the scene, being frequently
darkened by autumnal clouds; and the equinoctial gale swept the
surface of the lake, marking its blackness with long white lines, and
beating its waves over the rocks to the foliage of the thickets above.
The trees, that shade these eminences, give greater force to the
scenes, which they either partially exclude, or wholly admit, and
become themselves fine objects, enriched as they are with the
darkest moss.

From hence the ride to the village of Patterdale, at the lake's head,
is, for the first part, over precipices covered with wood, whence you
look down, on the left, upon the water, or upon pastures stretching
to it; on the right, the rocks rise abruptly, and often impend their
masses over the road; or open to narrow dells, green, rocky and
overlooked by endless mountains.

About half way to the village of Patterdale, a peninsula spreads

from this shore into the lake, where a white house, peeping from a
grove and surrounded with green enclosures, is beautifully placed.
This is an inn, and, perhaps the principal one, as to accommodation;
but, though its situation on a spot which on each side commands the
lake, is very fine, it is not comparable, in point of wildness and
sublimity, to that of the cottage, called the King's Arms, at
Patterdale. In the way thither, are enchanting catches of the lake,
between the trees on the left, and peeps into the glens, that wind
among the alps towards Helvellyn, on the right. These multiply near
the head of Ullswater, where they start off as from one point, like
radii, and conclude in trackless solitudes.

It is difficult to spread varied pictures of such scenes before the

imagination. A repetition of the same images of rock, wood and
water, and the same epithets of grand, vast and sublime, which
necessarily occur, must appear tautologous, on paper, though their
archetypes in nature, ever varying in outline, or arrangement, exhibit
new visions to the eye, and produce new shades of effect on the
mind. It is difficult, also, where these delightful differences have
been experienced, to forbear dwelling on the remembrance, and
attempting to sketch the peculiarities, which occasioned them. The
scenery at the head of Ullswater is especially productive of such
difficulties, where a wish to present the picture, and a consciousness
of the impossibility of doing so, except by the pencil, meet and
oppose each other.

Patterdale itself is a name somewhat familiar to recollection, from

the circumstance of the chief estate in it having given to its
possessors, for several centuries, the title of Kings of Patterdale. The
last person so distinguished was richer than his ancestors, having
increased his income, by the most ludicrous parsimony, to a
thousand pounds a year. His son and successor is an industrious
country gentleman, who has improved the sort of farming mansion,
annexed to the estate, and, not affecting to depart much from the
simple manners of the other inhabitants, is respectable enough to be
generally called by his own name of Mounsey, instead of the title,
which was probably seldom given to his ancestors, but in some sort
of mockery.
 The village is very humble, as to the conditions and views of the
inhabitants; and very respectable, as to their integrity and simplicity,
and to the contentment, which is proved by the infrequency of
emigrations to other districts. It straggles at the feet of fells,
somewhat removed from the lake and near the entrance of the wild
vale of Glenridding. Its white church is seen nearly from the
commencement of the last reach, rising among trees, and in the
church-yard are the ruins of an antient yew, of remarkable size and
venerable beauty; its trunk, hollowed and silvered by age, resembles
twisted roots; yet the branches, that remain above, are not of
melancholy black, but flourish in rich verdure and flaky foliage.

The inn is beyond the village, securely sheltered under high crags,
while enormous fells, close on the right, open to the gorge of
Patterdale; and Coldrill-beck, issuing from it, descends among the
corn and meadows, to join the lake at little distance. We had a
happy evening at this cleanly cottage, where there was no want,
without its recompense, from the civil offices of the people. Among
the rocks, that rose over it, is a station, which has been more
frequently selected than any other on the lake by the painter and
the lover of the beau idée, as the French and Sir Joshua Reynolds
expressively term what Mr. Burke explains in his definition of the
word fine. Below the point, on which we stood, a tract of corn and
meadow land fell gently to the lake, which expanded in great
majesty beyond, bounded on the right by the precipices of many
fells, and, on the left, by rocks finely wooded, and of more broken
and spiry outline. The undulating pastures and copses of Gowbarrow
closed the perspective. Round the whole of these shores, but
particularly on the left, rose clusters of dark and pointed summits,
assuming great variety of shape, amongst which Helvellyn was still
pre-eminent. Immediately around us, all was vast and gloomy; the
fells mount swiftly and to enormous heights, leaving at their bases
only crags and hillocks, tufted with thickets of dwarf-oak and holly,
where the beautiful cattle, that adorned them, and a few sheep,
were picking a scanty supper among the heath.
 From this spot glens open on either hand, that lead the eye only
to a chaos of mountains. The profile of one near the fore-ground on
the right is remarkably grand, shelving from the summit in one vast
sweep of rock, with only some interruption of craggy points near its
base, into the water. On one side, it unites with the fells in the gorge
of Patterdale, and, on the other, winds into a bold bay for the lake.
Among the highlands, seen over the left shore, is Common-fell, a
large heathy mountain, which appeared to face us. Somewhat
nearer, is a lower one, called Glenridding, and above it the Nab.
Grassdale has Glenridding and the Nab on one side towards the
water, and Birks-fell and St. Sunday's-crag over that, on the other.
The points, that rise above the Nab, are Stridon-edge, then Cove's
head, and, over all, the precipices of dark Helvellyn, now appearing
only at intervals among the clouds.

Not only every fell of this wild region has a name, but almost
every crag of every fell, so that shepherds sitting at the fire-side can
direct each other to the exact spot among the mountains, where a
stray sheep has been seen.

Among the rocks on the right shore, is Martindale-fell, once

shaded with a forest, from which it received its name, and which
spreading to a vast extent over the hills and vallies beyond, even as
far as Hawswater, darkened the front of Swarth-fell and several
others, that impend over the first and second reach of Ullswater. Of
the mountains, which tower above the glen of Patterdale, the
highest are Harter's fell, Kidstow-pike, and the ridge, called the
High-street; a name, which reminded us of the German
denomination, Berg-strasse.

The effect of a stormy evening upon the scenery was solemn.

Clouds smoked along the fells, veiling them for a moment, and
passing on to other summits; or sometimes they involved the lower
steeps, leaving the tops unobscured and resembling islands in a
distant ocean. The lake was dark and tempestuous, dashing the
rocks with a strong foam. It was a scene worthy of the sublimity of
Ossian, and brought to recollection some touches of his gloomy
pencil. "When the storms of the mountains come, when the north
lifts the waves on high, I sit by the sounding shore, &c."

A large hawk, sailing proudly in the air, and wheeling among the
stormy clouds, superior to the shock of the gust, was the only
animated object in the upward prospect. We were told, that the
eagles had forsaken their aeries in this neighbourhood and in
Borrowdale, and are fled to the isle of Man; but one had been seen
in Patterdale, the day before, which, not being at its full growth,
could not have arrived from a great distance.

We returned to our low-roofed habitation, where, as the wind

swept in hollow gusts along the mountains and strove against our
casements, the crackling blaze of a wood fire lighted up the
cheerfulness, which, so long since as Juvenal's time, has been
allowed to arise from the contrast of ease against difficulty. Suave
mari magno, turbantibus aquora ventis; and, however we might
exclaim,

—— —— ——"be my retreat
Between the groaning forest and the shore,
Beat by the boundless multitude of waves!"

it was pleasant to add,

"Where ruddy fire and beaming tapers join

To cheer the gloom."

BROUGHAM CASTLE.
The next morning, we proceeded from Ullswater along the vale of
Emont, so sweetly adorned by the woods and lawns of Dalemain,
the seat of Mr. Hassel, whose mansion is seen in the bottom. One of
the most magnificent prospects in the country is when this vale
opens to that of Eden. The mountainous range of Cross-fell fronted
us, and its appearance, this day, was very striking, for the effect of
autumnal light and shade. The upper range, bright in sunshine,
appeared to rise, like light clouds above the lower, which was
involved in dark shadow, so that it was a considerable time before
the eye could detect the illusion. The effect of this was inexpressibly
interesting.

Within view of Emont bridge, which divides the counties of

Cumberland and Westmoreland, is that memorial of antient times, so
often described under the name of Arthur's Round Table; a green
circular spot of forty paces diameter, enclosed by a dry ditch, and,
beyond this, by a bank; each in sufficient preservation to shew
exactly what has been its form. In the midst of the larger circle is
another of only seven paces diameter. We have no means of adding
to, or even of corroborating any of the well known conjectures,
concerning the use of this rude and certainly very antient
monument. Those not qualified to propose decisions in this respect
may, however, suffer themselves to believe, that the bank without
the ditch and the enclosure within it were places for different classes
of persons, interested as parties, or spectators, in some transactions,
passing within the inner circle; and that these, whether religious,
civil, or military ceremonies, were rendered distinct and conspicuous,
for the purpose of impressing them upon the memory of the
spectators, at a time when memory and tradition were the only
preservatives of history.

Passing a bridge, under which the Lowther, from winding and

romantic banks, enters the vale of Eden, we ascended between the
groves of Bird's Nest, or, as it is now called, Brougham Hall; a white
mansion, with battlements and gothic windows, having formerly a
bird painted on the front. It is perched among woods, on the brow
of a steep, but not lofty hill, and commands enchanting prospects
over the vale. The winding Emont; the ruins of Brougham Castle on
a green knoll of Whinfield park, surrounded with old groves; far
beyond this, the highlands of Cross-fell; to the north, Carleton-hall,
the handsome modern mansion of Mr. Wallace, amidst lawns of
incomparable verdure and luxuriant woods falling from the heights;
further still, the mountain, town and beacon of Penrith; these are
the principal features of the rich landscape, spread before the eye
from the summit of the hill, at Bird's Nest.

As we descended to Brougham Castle, about a mile further, its

ruined masses of pale red stone, tufted with shrubs and plants,
appeared between groves of fir, beach, oak and ash, amidst the
broken ground of Whinfield park, a quarter of a mile through which
brought us to the ruin itself. It was guarded by a sturdy mastiff,
worthy the office of porter to such a place, and a good effigy of the
Sir Porter of a former age. Brougham Castle, venerable for its well-
certified antiquity and for the hoary masses it now exhibits, is
rendered more interesting by having been occasionally the residence
of the humane and generous Sir Philip Sydney; who had only to look
from the windows of this once noble edifice to see his own "Arcadia"
spreading on every side. The landscape probably awakened his
imagination, for it was during a visit here, that the greatest part of
that work was written.

This edifice, once amongst the strongest and most important of

the border fortresses, is supposed to have been founded by the
Romans; but the first historical record concerning it is dated in the
time of William the Conqueror, who granted it to his nephew, Hugh
de Albinois. His successors held it, till 1170, when Hugh de Morville,
one of the murderers of Thomas a Becket, forfeited it by his crime.
Brougham was afterwards granted by King John to a grandson of
Hugh, Robert de Vipont, whose grandson again forfeited the estate,
which was, however, restored to his daughters, one of whom
marrying a De Clifford, it remained in this family, till a daughter of
the celebrated Countess of Pembroke gave it by marriage to that of
the Tuftons, Earls of Thanet, in which it now remains.
 This castle has been thrice nearly demolished; first by neglect,
during the minority of Roger de Vipont, after which it was sufficiently
restored to receive James the First, on his return from Scotland, in
1617; secondly, in the civil wars of Charles the First's time; and
thirdly, in 1728, when great part of the edifice was deliberately taken
down, and the materials sold for one hundred pounds. Some of the
walls still remaining are twelve feet thick, and the places are visible,
in which the massy gates were held to them by hinges and bolts of
uncommon size. A fuller proof of the many sacrifices of comfort and
convenience, by which the highest classes in former ages were glad
to purchase security, is very seldom afforded, than by the three
detached parts still left of this edifice; but they shew nothing of the
magnificence and gracefulness, which so often charm the eye in
gothic ruins. Instead of these, they exhibit symptoms of the
cruelties, by which their first lords revenged upon others the
wretchedness of the continual suspicion felt by themselves.
Dungeons, secret passages and heavy iron rings remain to hint of
unhappy wretches, who were, perhaps, rescued only by death from
these horrible engines of a tyrant's will. The bones probably of such
victims are laid beneath the damp earth of these vaults.

A young woman from a neighbouring farm-house conducted us

over broken banks, washed by the Emont, to what had been the
grand entrance of the castle; a venerable gothic gateway, dark and
of great depth, passing under a square tower, finely shadowed by
old elms. Above, are a cross-loop and two tier of small pointed
windows; no battlements appear at the top; but four rows of
corbells, which probably once supported them, now prop some tufts
of antient thorn, that have roots in their fractures.

As we passed under this long gateway, we looked into what is still

called the Keep, a small vaulted room, receiving light only from loops
in the outward wall; Near a large fire-place, yet entire, is a trap door
leading to the dungeon below; and, in an opposite corner, a door-
case to narrow stairs, that wind up the turret where, too, as well as
in the vault, prisoners were probably secured. One almost saw the
surly keeper descending through this door-case, and heard him
rattle the keys of the chambers above, listening with indifference to
the clank of chains and to the echo of that groan below, which
seemed to rend the heart it burst from.

This gloomy gateway, which had once sounded with the trumpets
and horses of James the First, when he visited the Earl of
Cumberland, this gateway, now serving only to shelter cattle from
the storm, opens, at length, to a grassy knoll, with bold masses of
the ruin scattered round it and a few old ash trees, waving in the
area. Through a fractured arch in the rampart some features in the
scenery without appear to advantage; the Emont falling over a weir
at some distance, with fulling-mills on the bank above; beyond, the
pastured slopes and woodlands of Carleton park, and Cross-fell
sweeping the back-ground.

Of the three ruinous parts, that now remain of the edifice, one
large square mass, near the tower and gateway, appears to have
contained the principal apartments; the walls are of great height,
and, though roofless, nearly entire. We entered what seemed to
have been the great hall, now choaked with rubbish and weeds. It
was interesting to look upwards through the void, and trace by the
many window-cases, that appeared at different heights in the walls,
somewhat of the plan of apartments, whose floors and ceilings had
long since vanished; majestic reliques, which shewed, that here, as
well as at Hardwick, the chief rooms had been in the second story.
Door-cases, that had opened to rooms without this building, with
remains of passages within the walls, were frequently seen, and,
here and there, in a corner at a vast height, fragments of a winding
stair-case, appearing beyond the arch of a slender door-way.

We were tempted to enter a ruinous passage below, formed in the

great thickness of the walls; but it was soon lost in darkness, and we
were told that no person had ventured to explore the end of this, or
of many similar passages among the ruins, now the dens of serpents
and other venomous reptiles. It was probably a secret way to the
great dungeon, which may still be seen, underneath the hall; for the
roof remains, though what was called the Sweating Pillar, from the
dew, that was owing to its damp situation and its seclusion from
outward air, no longer supports it. Large iron rings, fastened to the
carved heads of animals, are still shewn in the walls of this dungeon.
Not a single loop-hole was left by the contriver of this hideous vault
for the refreshment of prisoners; yet were they insulted by some
display of gothic elegance, for the pillar already mentioned,
supporting the centre of the roof, spread from thence into eight
branches, which descended the walls, and terminated at the floor in
the heads, holding the iron rings.

The second mass of the ruin, which, though at a considerable

distance from the main building, was formerly connected with it,
shews the walls of many small chambers, with reliques of the
passages and stairs, that led to them. But, perhaps, the only
picturesque feature of the castle is the third detachment; a small
tower finely shattered, having near its top a flourishing ash, growing
from the solid walls, and overlooking what was once the moat. We
mounted a perilous stair-case, of which many steps were gone, and
others trembled to the pressure; then gained a turret, of which two
sides were also fallen, and, at length, ascended to the whole
magnificence and sublimity of the prospect.

To the east, spread nearly all the rich vale of Eden, terminated by
the Stainmore hills and other highlands of Yorkshire; to the north-
east, the mountains of Cross-fell bounded the long landscape. The
nearer grounds were Whinfield-park, broken, towards the Emont,
into shrubby steeps, where the deep red of the soil mingled with the
verdure of foliage; part of Sir Michael le Fleming's woods rounding a
hill on the opposite bank, and, beyond, a wide extent of low land. To
the south, swelled the upland boundaries of Bampton-vale, with
Lowther-woods, shading the pastures and distantly crowned by the
fells of Hawswater; more to the west, Bird's Nest, "bosomed high in
tufted trees;" at its foot, Lowther-bridge, and, a little further, the
neat hamlet and bridge of Emont. In the low lands, still nearer, the
Lowther and Emont united, the latter flowing in shining circles
among the woods and deep-green meadows of Carleton-park.
Beyond, at a vast distance to the west and north, rose all the alps of
all the lakes! an horizon scarcely to be equalled in England. Among
these broken mountains, the shaggy ridge of Saddleback was
proudly pre-eminent; but one forked top of its rival Skiddaw peeped
over its declining side. Helvellyn, huge and misshapen, towered
above the fells of Ullswater. The sun's rays, streaming from beneath
a line of dark clouds, that overhung the west, gave a tint of silvery
light to all these alps, and reminded us of the first exquisite
appearance of the mountains, at Goodesberg, which, however, in
grandeur and elegance of outline, united with picturesque richness,
we have never seen equalled.

Of the walls around us every ledge, marking their many stories,

was embossed with luxuriant vegetation. Tufts of the hawthorn
seemed to grow from the solid stone, and slender saplings of ash
waved over the deserted door-cases, where, at the transforming
hour of twilight, the superstitious eye might mistake them for
spectres of some early possessor of the castle, restless from guilt, or
of some sufferer persevering from vengeance.

THE TOWN AND BEACON OF PENRITH.

Having pursued the road one mile further, for the purpose of
visiting the tender memorial of pious affection, so often described
under the name of Countess' Pillar, we returned to Emont-bridge,
and from thence reached Penrith, pronounced Peyrith, the most
southern town of Cumberland. So far off as the head of Ullswater,
fourteen miles, this is talked of as an important place, and looked to
as the store-house of whatever is wanted more than the fields and
lakes supply. Those, who have lived chiefly in large towns, have to
learn from the wants and dependencies of a people thinly scattered,
like the inhabitants of all mountainous regions, the great value of
any places of mutual resort, however little distinguished in the
general view of a country. Penrith is so often mentioned in the
neighbourhood, that the first appearance of it somewhat
disappointed us, because we had not considered how many serious
reasons those, who talked of it, might have for their estimation,
which should yet not at all relate to the qualities, that render places
interesting to a traveller.

The town, consisting chiefly of old houses, straggles along two

sides of the high north road, and is built upon the side of a
mountain, that towers to great height above it, in steep and heathy
knolls, unshaded by a single tree. Eminent, on the summit of this
mountain, stands the old, solitary beacon, visible from almost every
part of Penrith, which, notwithstanding its many symptoms of
antiquity, is not deficient of neatness. The houses are chiefly white,
with door and window cases of the red stone found in the
neighbourhood. Some of the smaller have over their doors dates of
the latter end of the sixteenth century. There are several inns, of
which that called Old Buchanan's was recommended to us, first, by
the recollection, that Mr. Gray had mentioned it, and afterwards by
the comfort and civility we found there.

Some traces of the Scottish dialect and pronunciation appear as

far south as Lancashire; in Westmoreland, they become stronger;
and, at Penrith, are extremely distinct and general, serving for one
among many peaceful indications of an approach, once notified
chiefly by preparations for hostility, or defence. Penrith is the most
southern town in England at which the guinea notes of the Scotch
bank are in circulation. The beacon, a sort of square tower, with a
peaked roof and openings at the sides, is a more perfect instance of
the direful necessities of past ages, than would be expected to
remain in this. The circumstances are well known, which made such
watchfulness especially proper, at Penrith; and the other traces of
warlike habits and precautions, whether appearing in records, or
buildings, are too numerous to be noticed in a sketch, which rather
pretends to describe what the author has seen, than to enumerate
what has been discovered by the researches of others. Dr. Burn's
History contains many curious particulars; and there are otherwise
abundant and satisfactory memorials, as to the state of the
debateable ground, the regulations for securing passes or fords, and
even to the public maintenance of slough dogs, which were to
pursue aggressors with hot trod, as the inhabitants were to follow
them by horn and voice. These are all testimonies, that among the
many evils, inflicted upon countries by war, that, which is not
commonly thought of, is not the least; the public encouragement of
a disposition to violence, under the names of gallantry, or valour,
which will not cease exactly when it is publicly prohibited; and the
education of numerous bodies to habits of supplying their wants, not
by constant and useful labour, but by sudden and destructive
exertions of force. The mistake, by which courage is released from
all moral estimation of the purposes, for which it is exerted, and is
considered to be necessarily and universally a good in itself, rather
than a means of good, or of evil, according to its application, is
among the severest misfortunes of mankind. Tacitus has an
admirable reproof of it—

"Ubi manu agitur, modestia et probitas nomina superioris

sunt."

Though the situation of Penrith, looking up the vales of Eden and

Emont, is remarkably pleasant, that of the beacon above is infinitely
finer, commanding an horizon of at least an hundred miles diameter,
filled with an endless variety of beauty, greatness and sublimity. The
view extends over Cumberland, parts of Westmoreland, Lancashire,
Yorkshire, and a corner of Northumberland and Durham. On a clear
day, the Scottish high lands, beyond Solway Firth, may be
distinguished, like faint clouds on the horizon, and the steeples of
Carlisle are plainly visible. All the intervening country, speckled with
towns and villages, is spread beneath the eye, and, nearly eighty
miles to the eastward, part of the Cheviot-hills are traced, a dark
line, binding the distance and marking the separation between earth
and sky. On the plains towards Carlisle, the nearer ridges of Cross-
fell are seen to commence, and thence stretch their barren steeps
thirty miles towards the east, where they disappear among the
Stainmore-hills and the huge moorlands of Yorkshire, that close up
the long landscape of the vale of Eden. Among these, the broken
lines of Ingleborough start above all the broader ones of the moors,
and that mountain still proclaims itself sovereign of the Yorkshire
heights.

Southward, rise the wonders of Westmoreland, Shapfells, ridge

over ridge, the nearer pikes of Hawswater, and then the mountains
of Ullswater, Helvellyn pre-eminent amongst them, distinguished by
the grandeur and boldness of their outline, as well as the variety of
their shapes; some hugely swelling, some aspiring in clusters of
alpine points, and some broken into shaggy ridges. The sky,
westward from hence and far to the north, displays a vision of Alps,
Saddleback spreading towards Keswick its long shattered ridge, and
one top of Skiddaw peering beyond it; but the others of this district
are inferior in grandeur to the fells of Ullswater, more broken into
points, and with less of contrast in their forms. Behind Saddleback,
the skirts of Skiddaw spread themselves, and thence low hills shelve
into the plains of Cumberland, that extend to Whitehaven; the only
level line in the scope of this vast horizon. The scenery nearer to the
eye exhibited cultivation in its richest state, varied with pastoral and
sylvan beauty; landscapes embellished by the elegancies of art, and
rendered venerable by the ruins of time. In the vale of Eden,
Carleton-hall, flourishing under the hand of careful attention, and
Bird's Nest, luxuriant in its spiry woods, opposed their cheerful
beauties to the neglected walls of Brougham Castle, once the terror,
and, even in ruins, the pride of the scene, now half-shrouded in its
melancholy grove. These objects were lighted up by partial gleams
of sunshine, which, as they fled along the valley, gave magical effect
to all they touched.

The other vales in the home prospect were those of Bampton and
Emont; the first open and gentle, shaded by the gradual woods of
Lowther-park; the last closer and more romantic, withdrawing in
many a lingering bend towards Ullswater, where it is closed by the
pyramidal Dunmallard, but not before a gleam of the lake is suffered
to appear beyond the dark base of the hill. At the nearer end of the
vale, and immediately under the eye, the venerable ruins of Penrith
Castle crest a round green hill. These are of pale red stone, and
stand in detached masses; but have little that is picturesque in their
appearance, time having spared neither tower, or gateway, and not a
single tree giving shade, or force, to the shattered walls. The ground
about the castle is broken into grassy knolls, and only cattle wander
over the desolated tract. Time has also obscured the name of the
founder; but it is known, that the main building was repaired, and
some addition made to it by Richard the Third, when Duke of
Gloucester, who lived here, for five years, in his office of sheriff of
Cumberland, promoting the York interest by artful hospitalities, and
endeavouring to strike terror into the Lancastrians. Among the ruins
is a subterraneous passage, leading to a house in Penrith, above
three hundred yards distant, called Dockwray Castle. The town lies
between the fortress and the Beacon-hill, spreading prettily along
the skirts of the mountain, with its many roofs of blue slate, among
which the church rises near a dark grove.

Penrith, from the latter end of the last century, till lately, when it
was purchased the Duke of Devonshire, belonged to the family of
Portland, to whom it was given by William the Third; probably
instead of the manors in Wales, which it was one of William's few
faulty designs so have given to his favourite companion, had not
Parliament remonstrated, and informed him, that the Crown could
not alienate the territories of the Principality. The church, a building
of red stone, unusually well disposed in the interior, is a vicarage of
small endowment; but the value of money in this part of the
kingdom is so high, that the merit of independence, a merit and a
happiness which should always belong to clergymen, is attainable by
the possessors of very moderate incomes. What is called the Giant's
Grave in the church yard is a narrow spot, inclosed, to the length of
fourteen or fifteen feet, by rows of low stones, at the sides, and, at
the ends, by two pillars, now slender, but apparently worn by the
weather from a greater thickness. The height of these is eleven or
twelve feet; and all the stones, whether in the borders, at the sides,
or in these pillars, bear traces of rude carving, which shew, at least,
that the monument must have been thought very important by those
that raised it, since the singularity of its size was not held a sufficient
distinction. We pored intently over these traces, though certainly
without the hope of discovering any thing not known to the eminent
antiquarians, who have confessed their ignorance concerning the
origin of them.

FROM PENRITH TO KESWICK.

The Graystock road, which we took for the first five or six miles, is
uninteresting, and offers nothing worthy of attention, before the
approach to the castle, the seat of the Duke of Norfolk. The
appearance of this from the road is good; a gray building, with
gothic towers, seated in a valley among lawns and woods, that
stretch, with great pomp of shade, to gently-rising hills. Behind
these, Saddleback, huge, gray and barren, rises with all its ridgy
lines; a grand and simple back-ground, giving exquisite effect to the
dark woods below. Such is the height of the mountain, that, though
eight or ten miles off, it appeared, as we approached the castle,
almost to impend over it. Southward from Saddleback, a multitude
of pointed summits crowd the horizon; and it is most interesting,
after leaving Graystock, to observe their changing attitudes, as you
advance, and the gradual disclosure of their larger features. Perhaps,
a sudden display of the sublimest scenery, however full, imparts less
emotion, than a gradually increasing view of it; when expectation
takes the highest tone, and imagination finishes the sketch.

About two miles beyond Graystock, the moorlands commence,

and, as far as simple greatness constitutes sublimity, this was,
indeed, a sublime prospect; less so only than that from Shap-fell
itself, where the mountains are not so varied in their forms and are
plainer in their grandeur. We were on a vast plain, if plain that may
be called, which swells into long undulations, surrounded by an
amphitheatre of heathy mountains, that seem to have been shook
by some grand convulsion of the earth, and tumbled around in all
shapes. Not a tree, a hedge, and seldom even a stone wall, broke
the grandeur of their lines; what was not heath was only rock and
gray crags; and a shepherd's hut, or his flocks, browsing on the
steep sides of the fells, or in the narrow vallies, that opened
distantly, was all that diversified the vast scene. Saddleback spread
his skirts westward along the plain, and then reared himself in
terrible and lonely majesty. In the long perspective beyond, were the
crowding points of the fells round Keswick, Borrowdale, and the
vales, of St. John and Leyberthwaite, stretching away to those near
Grasmere. The weather was in solemn harmony with the scenery;
long shadows swept over the hills, followed by gleaming lights.
Tempestuous gusts alone broke the silence. Now and then, the sun's
rays had a singular appearance; pouring, from under clouds,
between the tops of fells into some deep vale, at a distance, as into
a focus.

This is the very region, which the wild fancy of a poet, like
Shakespeare, would people with witches, and shew them at their
incantations, calling spirits from the clouds and spectres from the
earth.

On the now lonely plains of this vast amphitheatre, the Romans

had two camps, and their Eagle spread its wings over a scene
worthy of its own soarings. The lines of these encampments may
still be traced on that part of the plain, called Hutton Moor, to the
north of the high road; and over its whole extent towards Keswick a
Roman way has been discovered. Funereal urns have also been dug
up here, and an altar of Roman form, but with the inscription
obliterated.
 Nearer Saddleback, we perceived crags and heath mingling on its
precipices, and its base broken into a little world of mountains,
green with cultivation. White farms, each with its grove to shelter it
from the descending gusts, corn and pastures of the brightest
verdure enlivened the skirts of the mountain all round, climbing
towards the dark heath and crags, or spreading downwards into the
vale of Threlkeld, where the slender Lowther shews his shining
stream.

Leaving Hutton Moor, the road soon began to ascend the skirts of
Saddleback, and passed between green hillocks, where cattle
appeared most elegantly in the mountain scene, under the crags, or
sipping at the clear stream, that gushed from the rocks, and wound
to the vale below. Such crystal rivulets crossed our way continually,
as we rose upon the side of Saddleback, which towers abruptly on
the right, and, on the left, sinks as suddenly into the vale of
Threlkeld, with precipices sometimes little less than tremendous.
This mountain is the northern boundary of the vale in its whole
length to Keswick, the points of whose fells close the perspective.
Rocky heights guard it to the south. The valley between is green,
without wood, and, with much that is grand, has little beautiful, till
near its conclusion; where, more fertile and still more wild, it divides
into three narrower vallies, two of which disclose scenes of such
sublime severity as even our long view of Saddleback had not
prepared us to expect.

The first of these is the vale of St. John, a narrow, cultivated spot,
lying in the bosom of tremendous rocks, that impend over it in
masses of gray crag, and often resemble the ruins of castles. These
rocks are overlooked by still more awful mountains, that fall in
abrupt lines, and close up the vista, except where they also are
commanded by the vast top of Helvellyn. On every side, are images
of desolation and stupendous greatness, closing upon a narrow line
of pastoral richness; a picture of verdant beauty, seen through a
frame of rock work. It is between the cliffs of Threlkeld-fell and the
purple ridge of Nadale-fell, that this vale seems to repose in its most
silent and perfect peace. No village and scarcely a cottage disturbs
its retirement. The flocks, that feed at the feet of the cliffs, and the
steps of a shepherd, "in this office of his mountain watch," are all,
that haunt the "dark sequestered nook."

The vale of Nadale runs parallel with that of St. John, from which
it is separated by the ridge of Nadale-fell, and has the same style of
character, except that it is terminated by a well wooded mountain.
Beyond this, the perspective is overlooked by the fells, that
terminate the vale of St. John.

The third valley, opening from the head of Threlkeld, winds along
the feet of Saddleback and Skiddaw to Keswick, the approach to
which, with all its world of rocky summits, the lake being still sunk
below the sight, is sublime beyond the power of description. Within
three miles of Keswick, Skiddaw unfolds itself, close behind
Saddleback; their skirts unite, but the former is less huge and of
very different form from the last; being more pointed and seldomer
broken into precipices, it darts upward with a vast sweep into three
spiry summits, two of which only are seen from this road, and shews
sides dark with heath and little varied with rock. Such is its aspect
from the Penrith road; from other stations its attitude, shape and
colouring are very different, though its alpine terminations are
always visible.

Threlkeld itself is a small village, about thirteen miles from Penrith,

with a very humble inn, at which those, who have passed the bleak
sides of Saddleback, and those, who are entering upon them, may
rejoice to rest. We had been blown about, for some hours, in an
open chaise, and hoped for more refreshment than could be
obtained; but had the satisfaction, which was, indeed, general in
these regions, of observing the good intentions, amounting almost
to kindness, of the cottagers towards their guests. They have nearly
always some fare, which less civility than theirs might render
acceptable; and the hearth blazes in their clean sanded parlours,
within two minutes after you enter them. Some sort of preserved
fruit is constantly served after the repast, with cream, an innocent
luxury, for which no animal has died.

It is not only from those, who are to gain by strangers, but from
almost every person, accidentally accosted by a question, that this
favourable opinion will be formed, as to the kind and frank manners
of the people. We were continually remarking, between Lancaster
and Keswick, that severe as the winter might be in these districts,
from the early symptoms of it then apparent, the conduct of the
people would render it scarcely unpleasant to take the same journey
in the depths of December.

In these countries, the farms are, for the most part, small, and the
farmers and their children work in the same fields with their
servants. Their families have thus no opportunities of temporary
insight into the society, and luxuries of the great, and have none of
those miseries, which dejected vanity and multiplied wishes inflict
upon the pursuers of the higher ranks. They are also without the
baseness, which such pursuers usually have, of becoming abject
before persons of one class, that by the authority of an apparent
connection with them, they may be insolent to those of another; and
are free from the essential humiliation of shewing, by a general and
undistinguishing admiration of all persons richer than themselves,
that the original distinctions between virtue and vice have been
erased from their minds by the habit of comparing the high and the
low.

The true consciousness of independence, which labour and an

ignorance of the vain appendages, falsely called luxuries, give to the
inhabitants of these districts, is probably the cause of the superiority,
perceived by strangers in their tempers and manners, over those of
persons, apparently better circumstanced. They have no
remembrance of slights, to be revenged by insults; no hopes from
servility, nor irritation from the desire of unattainable distinctions.
Where, on the contrary, the encouragement of artificial wants has
produced dependence, and mingled with the fictitious appearance of
wealth many of the most real evils of poverty, the benevolence of
the temper flies with the simplicity of the mind. There is, perhaps,
not a more odious prospect of human society, than where an
ostentatious, manœuvring and corrupted peasantry, taking those,
who induce them to crimes, for the models of their morality, mimic
the vices, to which they were not born, and attempts the coarse
covering of cunning and insolence for practices, which it is a science
and frequently an object of education to conceal by flagitious
elegancies. Such persons form in the country a bad copy of the
worst London society; the vices, without the intelligence, and
without the assuaging virtues.

DRUIDICAL MONUMENT.
After passing the very small, but neatly furnished church of
Threlkeld, the condition of which may be one testimony to the
worthiness of the neighbourhood, and rising beyond the vales before
described, we came to the brow of a hill, called Castle Rigg, on
which, to the left of the road, are the remains of one of those
circular monuments, which, by general consent, are called Druids'
Temples. This is formed of thirty-seven stones, placed in a circle of
about twenty-eight yards diameter, the largest being not less than
seven feet and a half high, which is double the height of the others.
At the eastern part of this circle, and within it, smaller stones are
arranged in an oblong of about seven yards long, and, at the
greatest breadth, four yards wide. Many of those round the circle
appear to have fallen and now remain at unequal distances, of which
the greatest is towards the north.

Whether our judgment was influenced by the authority of a Druid's

choice, or that the place itself commanded the opinion, we thought
this situation the most severely grand of any hitherto passed. There
is, perhaps, not a single object in the scene, that interrupts the
solemn tone of feeling, impressed by its general characters of
profound solitude, greatness and awful wildness. Castle Rigg is the
central point of three vallies, that dart immediately under it from the
eye, and whose mountains form part of an amphitheatre, which is
completed by those of Derwentwater, in the west, and by the
precipices of Skiddaw and Saddleback, close on the north. The hue,
which pervades all these mountains, is that of dark heath, or rock;
they are thrown into every form and direction, that Fancy would
suggest, and are at that distance, which allows all their grandeur to
prevail; nearer than the high lands, that surround Hutton Moor, and
further removed than the fells in the scenery of Ullswater.

To the south open the rocks, that disclose the vale of St. John,
whose verdant beauty bears no proportion to its sublimity; to the
west, are piled the shattered and fantastic points of Derwentwater;
to the north, Skiddaw, with its double top, resembling a volcano, the
cloudy vapours ascending from its highest point, like smoke, and
sometimes rolling in wreaths down its sides; and to the east, the
vale of Threlkeld, spreading green round the base of Saddleback, its
vast side-skreen, opened to the moorlands, beyond which the ridge
of Cross-fell appeared; its dignity now diminished by distance. This
point then is surrounded by the three grand rivals of Cumberland;
huge Helvellyn, spreading Saddleback and spiry Skiddaw.

Such seclusion and sublimity were, indeed, well suited to the deep
and wild mysteries of the Druids. Here, at moon-light, every Druid,
summoned by that terrible horn, never awakened but upon high
occasions, and descending from his mountain, or secret cave, might
assemble without intrusion from one sacrilegious footstep, and
celebrate a midnight festival by a savage sacrifice—

——"rites of such strange potency

As, done in open day, would dim the sun,
Tho' thron'd in noontide brightness."

Caractacus.
Here, too, the Bards,

"Rob'd in their flowing vests of innocent white,

Descend, with harps, that glitter to the moon,
Hymning immortal strains. The spirits of air,
Of earth, of water, nay of heav'n itself,
Do listen to their lay; and oft, 'tis said,
In visible shapes, dance they a magic round
To the high minstrelsy."

As we descended the steep mountain to Keswick, the romantic

fells round the lake opened finely, but the lake itself was concealed,
deep in its rocky cauldron. We saw them under the last glow of sun-
set, the upward rays producing a misty purple glory between the
dark tops of Cawsey-pikes and the bending peaks of Thornthwaite
fells. Soon after, the sun having set to the vale of Keswick, there
appeared, beyond breaks in its western mountains, the rocks of
other vallies, still lighted up by a purple gleam, and receiving strong
rays on shaggy points, to which their recesses gave soft and
shadowy contrast. But the magical effect of these sunshine rocks,
opposed to the darkness of the nearer valley, can scarcely be
imagined.

Still as we descended, the lake of Derwentwater was screened

from our view; but the rich level of three miles wide, that spreads
between it and Bassenthwaite-water in the same vale, lay, like a
map, beneath us, chequered with groves and cottages, with
enclosures of corn and meadows, and adorned by the pretty village
of Crossthwaite, its neat white church conspicuous among trees. The
fantastic fells of Derwentwater bordered this reposing landscape, on
the west, and the mighty Skiddaw rose over it, on the east,
concealing the lake of Bassenthwaite.

The hollow dashings of the Greta, in its rocky channel, at the foot
of Skiddaw, and in one of the most wizard little glens that nature
ever fancied, were heard long before we looked down its steep
woody bank, and saw it winding away, from close inaccessible
chasms, to the vale of Keswick, corn and meadows spread at the top
of the left bank, and the crags of Skiddaw scowling over it, on the
right.

At length, we had a glimpse of the north end of Derwentwater,

and soon after entered Keswick, a small place of stone houses, lying
at the foot of Castle Rigg, near Skiddaw, and about a quarter of a
mile from the lake, which, however, is not seen from the town.

We were impatient to view this celebrated lake, and immediately

walked down to Crow-park, a green eminence at its northern end,
whence it is generally allowed to appear to great advantage.
Expectation had been raised too high: Shall we own our
disappointment? Prepared for something more than we had already
seen, by what has been so eloquently said of it, by the view of its
vast neighbourhood and the grandeur of its approach, the lake itself
looked insignificant; and, however rude, or awful, its nearer rocks
might have appeared, if seen unexpectedly, they were not in general
so vast, or so boldly outlined, as to retain a character of sublimity
from comparison. Opposed to the simple majesty of Ullswater, the
lake of Derwent was scarcely interesting. Something must, indeed,
be attributed to the force of first impressions; but with all allowance
for this, Ullswater must still retain an high pre-eminence for
grandeur and sublimity.

Derwentwater, however, when more minutely viewed, has peculiar

charms both from beauty and wildness, and as the emotions, excited
by disappointed expectation, began to subside, we became sensible
of them. It seems to be nearly of a round form, and the whole is
seen at one glance, expanding within an amphitheatre of mountains,
rocky, but not vast, broken into many fantastic shapes, peaked,
splintered, impending, sometimes pyramidal, opening by narrow
vallies to the view of rocks, that rise immediately beyond and are
again overlooked by others. The precipices seldom overshoot the
water, but are arranged at some distance, and the shores swell with
woody eminences, or sink into green, pastoral margins. Masses of
wood also frequently appear among the cliffs, feathering them to
their summits, and a white cottage sometimes peeps from out their
skirts, seated on the smooth knoll of a pasture, projecting to the
lake, and looks so exquisitely picturesque, as to seem placed there
purposely to adorn it. The lake in return faithfully reflects the whole
picture, and so even and brilliantly translucent is its surface, that it
rather heightens, than obscures the colouring. Its mild bosom is
spotted by four small islands, of which those called Lords' and St.
Herbert's are well wooded, and adorn the scene, but another is
deformed by buildings, stuck over it, like figures upon a twelfth-
cake.

Beyond the head of the lake, and at a direct distance of three or

four miles from Crow-park, the pass of Borrowdale opens, guarded
by two piles of rock, the boldest in the scene, overlooked by many
rocky points, and, beyond all, by rude mountain tops which come
partially and in glimpses to the view. Among the most striking
features of the eastern shore are the woody cliffs of Lowdore; then,
nearer to the eye, Wallow-crags, a title used here as well as at
Hawswater, of dark brown rock, loosely impending; nearer still,
Castle-hill, pyramidal and richly wooded to its point, the most
luxuriant feature of the landscape. Cawsey-pike, one of the most
remarkable rocks of the western shore, has its ridge scolloped into
points as if with a row of corbells.

The cultivated vale of Newland slopes upward from the lake

between these and Thornthwaite fells. Northward, beyond Crow-
park, rises Skiddaw; at its base commences the beautiful level, that
spreads to Bassenthwaite-water, where the rocks in the west side of
the perspective soon begin to soften, and the vale becomes open
and cheerful.

Such is the outline of Derwentwater, which has a much greater

proportion of beauty, than Ullswater, but neither its dignity, nor
grandeur. Its fells, broken into smaller masses, do not swell, or start,
into such bold lines as those of Ullswater; nor does the size of the
lake accord with the general importance of the rocky vale, in which it
lies. The water is too small for its accompaniments; and its form,
being round and seen entirely at once, leaves nothing for
expectation to pursue, beyond the stretching promontory, or fancy
to transform within the gloom and obscurity of the receding fell; and
thus it loses an ample source of the sublime. The greatest breadth
from east to west is not more than three miles. It is not large
enough to occupy the eye, and it is not so hidden as to have the
assistance of the imagination in making it appear large. The beauty
of its banks also, contending with the wildness of its rocks, gives
opposite impressions to the mind, and the force of each is, perhaps,
destroyed by the admission of the other. Sublimity can scarcely exist,
without simplicity; and even grandeur loses much of its elevating
effect, when united with a considerable portion of beauty; then
descending to become magnificence. The effect of simplicity in
assisting that high tone of mind, produced by the sublime, is
demonstrated by the scenery of Ullswater, where very seldom a
discordant object obtrudes over the course of thought, and jars
upon the feelings.

But it is much pleasanter to admire than to examine, and in

Derwentwater is abundant subject for admiration, though not of so
high a character as that, which attends Ullswater. The soft
undulations of its shores, the mingled wood and pasture, that paint
them, the brilliant purity of the water, that gives back every
landscape on its bank, and frequently with heightened colouring, the
fantastic wildness of the rocks and the magnificence of the
amphitheatre they form; these are circumstances, the view of which
excites emotions of sweet, though tranquil admiration, softening the
mind to tenderness, rather than elevating it to sublimity. We first
saw the whole beneath such sober hues as prevailed when

"the gray hooded Even,

Like a sad votarist, in Palmer's weed,
Rose from the hindmost wheels of Phœbus' wain."
 The wildness, seclusion, and magical beauty of this vale, seem,
indeed, to render it the very abode for Milton's Comus, "deep skilled
in all his mother's witcheries;" and, while we survey its fantastic
features, we are almost tempted to suppose, that he has hurled his

"dazzling spells into the air,

Of power to cheat the eye with blear illusion
And give it false presentments,"

Nay more, to believe

"All the sage poets, taught by th' heavenly muse,

Storied of old, in high immortal verse,
Of dire chimæras and enchanted isles;"

and to fancy we hear from among the woody cliffs, near the shore,

"the sound
Of riot and ill manag'd merriment,"

succeeded by such strains as oft

"in pleasing slumbers lull the sense,

And, in sweet madness, rob it of itself."

SKIDDAW.
On the following morning, having engaged a guide, and with
horses accustomed to the labour, we began to ascend this
tremendous mountain by a way, which makes the summit five miles
from Keswick. Passing through bowery lanes, luxuriant with
mountain ash, holly, and a variety of beautiful shrubs, to a broad,
open common, a road led us to the foot of Latrigg, or, as it is called
by the country people, Skiddaw's Cub, a large round hill, covered
with heath, turf and browsing sheep. A narrow path now wound
along steep green precipices, the beauty of which prevented what
danger there was from being perceived. Derwentwater was
concealed by others, that rose above them, but that part of the vale
of Keswick, which separates the two lakes, and spreads a rich level
of three miles, was immediately below; Crossthwaite-church, nearly
in the centre, with the white vicarage, rising among trees. More
under shelter of Skiddaw, where the vale spreads into a sweet
retired nook, lay the house and grounds of Dr. Brownrigg.

Beyond the level, opened a glimpse of Bassenthwaite-water; a

lake, which may be called elegant, bounded, on one side, by well-
wooded rocks, and, on the other, by Skiddaw.

Soon after, we rose above the steeps, which had concealed

Derwentwater, and it appeared with all its enamelled banks, sunk
deep amidst a chaos of mountains, and surrounded by ranges of
fells, not visible from below. On the other hand, the more cheerful
lake of Bassenthwaite expanded at its entire length. Having gazed a
while on this magnificent scene, we pursued the path, and soon
after reached the brink of a chasm, on the opposite side of which
wound our future track; for the ascent is here in an acutely zig-zag
direction. The horses carefully picked their steps along the narrow
precipice, and turned the angle, that led them to the opposite side.

At length, as we ascended, Derwentwater dwindled on the eye to

the smallness of a pond, while the grandeur of its amphitheatre was
increased by new ranges of dark mountains, no longer individually
great, but so from accumulation; a scenery to give ideas of the
breaking up of a world. Other precipices soon hid it again, but
Bassenthwaite continued to spread immediately below us, till we
turned into the heart of Skiddaw, and were enclosed by its steeps.
We had now lost all track even of the flocks, that were scattered
over these tremendous wilds. The guide conducted us by many
curvings among the heathy hills and hollows of the mountain; but
the ascents were such, that the horses panted in the slowest walk,
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