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Test Bank for Medical-Surgical Nursing, 7th Edition by

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Medical-Surgical Nursing Assessment and Management of

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5. A patient who is paralyzed on the left side of the body after a stroke develops a pressure ulcer on the left hip. Which nursing
diagnosis is most appropriate?
a. Impaired physical mobility related to left-sided paralysis
b. Risk for impaired tissue integrity related to left-sided weakness
c. Impaired skin integrity related to altered circulation and pressure
d. Ineffective tissue perfusion related to inability to move independently
ANS: C
The patient’s major problem is the impaired skin integrity as demonstrated by the presence of a pressure ulcer. The nurse is able to
treat the cause of altered circulation and pressure by frequently repositioning the patient. Although left-sided weakness is a problem
for the patient, the nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this patient, who already has
impaired tissue integrity. The patient does have ineffective tissue perfusion, but the impaired skin integrity diagnosis indicates more
clearly what the health problem is.
DIF: Cognitive Level: Apply (application) REF: 7

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity
6. A patient with a bacterial infection has a nursing diagnosis of deficient fluid volume related to excessive diaphoresis. Which
outcome would the nurse recognize as appropriate for this patient?
a. Patient has a balanced intake and output.
b. Patient’s bedding is changed when it becomes damp.
c. Patient understands the need for increased fluid intake.
d. Patient’s skin remains cool and dry throughout hospitalization.
ANS: A
This statement gives measurable data showing resolution of the problem of deficient fluid volume that was identified in the nursing
diagnosis statement. The other statements would not indicate that the problem of deficient fluid volume was resolved.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
7. A nurse asks the patient if pain was relieved after receiving medication. What is the purpose of the evaluation phase of the nursing
process?
a. To determine if interventions have been effective in meeting patient outcomes
b. To document the nursing care plan in the progress notes of the medical record
c. To decide whether the patient’s health problems have been completely resolved
d. To establish if the patient agrees that the nursing care provided was satisfactory
ANS: A
Evaluation consists of determining whether the desired patient outcomes have been met and whether the nursing interventions were
appropriate. The other responses do not describe the evaluation phase.
DIF: Cognitive Level: Understand (comprehension) REF: 5

TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment
8. The nurse interviews a patient while completing the health history and physical examination. What is the purpose of the assessment
phase of the nursing process?
a. To teach interventions that relieve health problems
b. To use patient data to evaluate patient care outcomes
c. To obtain data with which to diagnose patient problems
d. To help the patient identify realistic outcomes for health problems
ANS: C
During the assessment phase, the nurse gathers information about the patient to diagnose patient problems. The other responses are
examples of the planning, intervention, and evaluation phases of the nursing process.

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
9. Which nursing diagnosis statement is written correctly?

a. Altered tissue perfusion related to heart failure
b. Risk for impaired tissue integrity related to sacral redness c.
Ineffective coping related to response to biopsy test results d.
Altered urinary elimination related to urinary tract infection
ANS: C
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a patient’s response to a health
problem that can be treated by nursing. The use of a medical diagnosis as an etiology (as in the responses beginning “Altered tissue
perfusion” and “Altered urinary elimination”) is not appropriate. The response beginning “Risk for impaired tissue integrity” uses
the defining characteristic as the etiology.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
Copyright © 2017, Elsevier Inc. All Rights Reserved. 2

10. The nurse admits a patient to the hospital and develops a plan of care. What components should the nurse include in the nursing
diagnosis statement?
a. The problem and the suggested patient goals or outcomes
b. The problem with possible causes and the planned interventions
c. The problem, its cause, and objective data that support the problem
d. The problem with an etiology and the signs and symptoms of the problem
ANS: D
When writing nursing diagnoses, this format should be used: problem, etiology, and signs and symptoms. The subjective, as well as
objective, data should be included in the defining characteristics. Interventions and outcomes are not included in the nursing
diagnosis statement.
DIF: Cognitive Level: Remember (knowledge) REF: 7

TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
11. A nurse is caring for a patient with heart failure. Which task is appropriate for the nurse to delegate to experienced unlicensed
assistive personnel (UAP)?
a. Monitor for shortness of breath or fatigue after ambulation.
b. Instruct the patient about the need to alternate activity and rest.
c. Obtain the patient’s blood pressure and pulse rate after ambulation.
d. Determine whether the patient is ready to increase the activity level.
ANS: C
UAP education includes accurate vital sign measurement. Assessment and patient teaching require registered nurse education and
scope of practice and cannot be delegated.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
12. A nurse is caring for a group of patients on the medical-surgical unit with the help of one float registered nurse (RN), one
unlicensed assistive personnel (UAP), and one licensed practical/vocational nurse (LPN/LVN). Which assignment, if delegated by
the nurse, would be inappropriate?
a. Measurement of a patient’s urine output by UAP
b. Administration of oral medications by LPN/LVN
c. Check for the presence of bowel sounds and flatulence by UAP
d. Care of a patient with diabetes by RN who usually works on the pediatric unit
ANS: C
Assessment requires RN education and scope of practice and cannot be delegated to an LPN/LVN or UAP. The other assignments
made by the RN are appropriate.

13. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)?
a. Complete the initial admission assessment and plan of care.
b. Document teaching completed before a diagnostic procedure.
c. Instruct a patient about low-fat, reduced sodium dietary restrictions.
d. Obtain bedside blood glucose on a patient before insulin administration.
ANS: D
The education and scope of practice of the LPN/LVN include activities such as obtaining glucose testing using a finger stick.
Patient teaching and the initial assessment and development of the plan of care are nursing actions that require registered nurse
education and scope of practice.

14. A nurse is assigned as a case manager for a hospitalized patient with a spinal cord injury. The patient can expect the nurse
functioning in this role to perform which activity?
a. Care for the patient during hospitalization for the injuries.
b. Assist the patient with home care activities during recovery.
c. Determine what medical care the patient needs for optimal rehabilitation.
d. Coordinate the services that the patient receives in the hospital and at home.
ANS: D
The role of the case manager is to coordinate the patient’s care through multiple settings and levels of care to allow the maximal
patient benefit at the least cost. The case manager does not provide direct care in either the acute or home setting. The case manager
coordinates and advocates for care but does not determine what medical care is needed; that would be completed by the health care
provider or other provider.

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

15. The nurse is caring for an older adult patient who had surgery to repair a fractured hip. The patient needs continued nursing care
and physical therapy to improve mobility before returning home. The nurse will help to arrange for transfer of this patient to which
facility?
a. A skilled care facility c. A transitional care facility
b. A residential care facility d. An intermediate care facility
ANS: C
Transitional care settings are appropriate for patients who need continued rehabilitation before discharge to home or to long-term
care settings. The patient is no longer in need of the more continuous assessment and care given in acute care settings. There is no
indication that the patient will need the permanent and ongoing medical and nursing services available in intermediate or skilled
care. The patient is not yet independent enough to transfer to a residential care facility.

TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
16. A home care nurse is planning care for a patient who has just been diagnosed with type 2 diabetes mellitus. Which task is
appropriate for the nurse to delegate to the home health aide?
a. Assist the patient to choose appropriate foods.
b. Help the patient with a daily bath and oral care.
c. Check the patient’s feet for signs of breakdown.
d. Teach the patient how to monitor blood glucose.
ANS: B
Assisting with patient hygiene is included in home health-aide education and scope of practice. Assessment of the patient and
instructing the patient in new skills, such as diet and blood glucose monitoring, are complex skills that are included in registered
nurse education and scope of practice.

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
17. The nurse is providing education to nursing staff on quality care initiatives. Which statement is an accurate description of the
impact of health care financing on quality care?
a. “If a patient develops a catheter-related infection, the hospital receives additional
funding.”
b. “Payment for patient care is primarily based on clinical outcomes and patient
satisfaction.”
c. “Hospitals are reimbursed for all costs incurred if care is documented
electronically.”
d. “Because hospitals are accountable for overall care, it is not nursing’s
responsibility to monitor care delivered by others.”
ANS: B
Payment for health care services programs reimburses hospitals for their performance on overall quality-of-care measures. These
measures include clinical outcomes and patient satisfaction. Nurses are responsible for coordinating complex aspects of patient
care, including the care delivered by others, and identifying issues that are associated with poor quality care. Payment for care can
be withheld if something happens to the patient that is considered preventable (e.g., acquiring a catheter-related urinary tract
infection).

18. The nurse documenting the patient’s progress in the care plan in the electronic health record before an interprofessional discharge
conference is demonstrating competency in which QSEN category?
a. Patient-centered care c. Evidence-based practice
b. Quality improvement d. Informatics and technology
ANS: D
The nurse is displaying competency in the QSEN area of informatics and technology. Using a computerized information system to
document patient needs and progress and communicate vital information regarding the patient with the interprofessional care team
members provides evidence that nursing practice standards related to the nursing process have been maintained during the care of
the patient.


MULTIPLE RESPONSE
1. Which information will the nurse consider when deciding what nursing actions to delegate to a licensed practical/vocational nurse
(LPN/LVN) who is working on a medical-surgical unit (select all that apply)?
a. Institutional policies
b. Stability of the patient
c. State nurse practice act
d. LPN/LVN teaching abilities
e. Experience of the LPN/LVN
ANS: A, B, C, E
The nurse should assess the experience of LPN/LVNs when delegating. In addition, state nurse practice acts and institutional
policies must be considered. In general, whereas the LPN/LVN scope of practice includes caring for patients who are stable,
registered nurses should provide most of the care for unstable patients. Because the LPN/LVN scope of practice does not include
patient education, this will not be part of the delegation process.

2. The nurse is administering medications to a patient. Which actions by the nurse during this process are consistent with promoting
safe delivery of care (select all that apply)?
a. Throws away a medication that is not labeled
b. Uses a hand sanitizer before preparing a medication
c. Identifies the patient by the room number on the door
d. Checks laboratory test results before administering a diuretic
e. Gives the patient a list of current medications upon discharge
ANS: A, B, D, E
National Patient Safety Goals have been established to promote safe delivery of care. The nurse should use at least two reliable
ways to identify the patient such as asking the patient’s full name and date of birth before medication administration. Other actions
that improve patient safety include performing hand hygiene, disposing of unlabeled medications, completing appropriate
assessments before administering medications, and giving a list of the current medicines to the patient and caregiver before
discharge.

OTHER
1. The nurse uses the Situation-Background-Assessment-Recommendation (SBAR) format to communicate a change in patient status
to a health care provider. In which order should the nurse make the following statements? (Put a comma and a space between each
answer choice [A, B, C, D].)
a. “The patient needs to be evaluated immediately and may need intubation and mechanical ventilation.”
b. “The patient was admitted yesterday with heart failure and has been receiving furosemide (Lasix) for diuresis, but urine output
has been low.”
c. “The patient has crackles audible throughout the posterior chest, and the most recent oxygen saturation is 89%. Her condition is
very unstable.”
d. “This is the nurse on the surgical unit. After assessing the patient, I am very concerned about increased shortness of breath over
the past hour.”
ANS:
D, B, C, A
The order of the nurse’s statements follows the SBAR format.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

Another random document with
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AN ANGLO-SAXON SHIP OF ABOUT THE
NINTH CENTURY.
(From Strutt.)
The Viking ships must have walked the waters almost with the grace
of motion of a modern yacht, and when the great square sail was
hoisted, bearing the escutcheon of some dread sea-rover, they must
have been fascinating emblems of human skill and power no less
than of the noblest and the basest passions of mankind.
The large rowing and sailing galleys of the Mediterranean were fine-
weather ships, it being the custom to suspend merchant voyages,
naval expeditions, and piracy in that sea during the winter months.
Obviously, such vessels were wholly unsuited to the Atlantic coasts
of Western Europe. The western coasts of Spain, France and
Portugal produced a ship, short and broad, and strong enough to be
beached even when a moderate sea was running. This model was
seemingly copied by the English of the south coast, and vessels of
this type, built in the eighth century, were planked and carried high,
erect stemposts and sternposts. The vessels were single-masted
and fitted with a yard and square sail, and the steering was effected
by a large oar at the stern. They were not unlike the Viking ships in
some respects, but they were of less average length and broader in
proportion, having bluffer bows, a less fine entry, and a long flat floor
extending farther aft than did that of the northern ships. Some also
had a ram.
VIKING SHIP FOUND AT GOKSTAD, SOUTH NORWAY.

Photograph: O. Vaering, Christiania.
What may be regarded as the first great national step in British

shipbuilding was inaugurated in the latter part of the ninth century,
when King Alfred saw that in order to beat the Danes he must meet
them with ships superior in size and strength to their own. His war
galleys were virtually double the size of those of the invaders, and in
some instances almost double their length. The Gokstad ship, by no
means one of the largest of its type, had sixteen oars a side. If
Alfred’s boats had thirty oars or more a side, as is stated, and were
double-banked—that is, two men to each oar—like those of his foes,
the fighting strength of the individual ships of his navy must have
been very great.
By the eleventh century the Norsemen had taken to painting their
vessels externally, besides making them larger and giving them
decks. The stempost and sternpost were more ornately decorated,
gilded copper being the material used for this purpose. Svend
Forkbeard’s own ship, the Great Dragon, is said to have been in the
form of this legendary beast, but what the historian most likely meant
is that the stern decoration or the design on the sail may have shown
a fantastic representation of the fearsome animal; the Vikings were
too good seamen to have built the ship in any form likely to be
inferior to the shape they had learned to appreciate so highly. The
Long Serpent, which appeared in that century, is said to have been
117 feet in length, and decked, and to have carried six hundred men.
This is the first war vessel in the Western seas known to have been
decked throughout,[7] and in which cabin accommodation was
provided for the principal fighting men. Beneath the deck the hull
was divided into five cabins or compartments; the foremost was the
lokit, in which, in a royal vessel, the king’s standard bearers were
quartered; next, the sax or storeroom; then the kraproom, where
sails and tackle were kept; the foreroom, containing the arms chest,
and forming the living room of the warriors; and astern of all was the
lofting, or great cabin, devoted to the commander. For the comfort of
the rank and file of the fighting men at night in port an awning was
spread, supported by a ridge pole on pillars. At other times they
would seem to have had to put up with sleeping on deck and making
the best of it; they would certainly be no worse off than in the old
days of the open ships, and being somewhat higher above the water
would be less exposed to the spray. At the end of the twelfth century
King Sverre Sigurdsson had some merchant ships cut across
amidships and lengthened, and then used them as war ships.
FLEET ATTACKING A FORTIFIED TOWN.
MS. Harl. 326.
William the Conqueror’s fleet in the eleventh century is estimated at

anything between six hundred and ninety-six vessels and three
thousand; a manuscript in the Bodleian Library gives the number as
one thousand. Most of the vessels were small, if the illustrations on
the Bayeux tapestry are to be accepted. The type of ship is no doubt
represented with a fair amount of accuracy, but in certain other
respects the efforts of the weavers of the tapestry are only less
grotesque than the so-called ships which appear on some of the
medals of the ports, but which nevertheless have been accepted as
correct representations of the ships of the times, whereas they
should be regarded as indicating approximately the type of vessel
then in vogue. With the exception that a few ships were built of
rather greater dimensions—the largest in the invading fleet can
hardly have been more than 80 tons burthen—shipbuilding shows
but little development on the Atlantic coast until after the introduction
of artillery.
WARSHIPS OF THE FOURTEENTH CENTURY.

(After Harleian MS.—1319. fol. 18.)
A battle between a Cinque Ports fleet under Hubert de Burgh and a
French fleet under Eustace is chiefly remarkable by reason of the
English manœuvring to secure the windward position, this being the
first occasion on which this manœuvre is recorded, and the attack on
the French rear ended in a signal English victory. The fame of the
English archers was great, and they added to their laurels by playing
no small part in the battle. From their positions in the tops and on the
forecastles they kept up a steady flight of arrows upon the French.
The arrows carried flasks of unslaked lime which broke on striking
the French ships, and the lime dust, borne on the wind, entered the
eyes of the enemy and blinded them, the defeat of the French
following. The ships of that period were provided with platforms,
elevated on wooden pillars, at the bow and stern. The erections were
the forerunners of the immense structures which were added in later
years and did so much to render ships unstable.
A Venetian ship constructed for Louis IX. of France in 1298, and
named the Roccafortis, was 70 feet long on the keel and 110 feet
over all, with a width at prow and poop of 40 feet. She is stated to
have had two decks and a fighting castle at each end. Possibly the
weight of the bellatorium, as the castle was called, may have
necessitated such an extraordinary beam near the bows and stern,
but she could never have been built with such dimensions to be
other than a floating fortress.
In the Mediterranean, however, great activity prevailed. The
Crusades gave a tremendous impetus to the shipping of the Middle
Sea. Christians and Saracens vied with each other in the production
of ships of war. The larger “busses” sent to the Levant in the fleet of
Richard Cœur de Lion carried, according to Richard of Devizes, a
captain and fifteen seamen, and forty knights with their horses, forty
footmen, fourteen servants, and twelve months’ provision for all.
Some vessels are said to have carried double this complement and
cargo. A Saracen ship, of which little is known, was encountered off
the Syrian coast, of so great a size that it could not be subdued until
the Christian galleys charged in line abreast and smashed in her
side so that she went down with nearly all of her one thousand five
hundred men.
A GALLEY OF THE KNIGHTS OF MALTA.
From the Model in the Victoria and Albert Museum.
MEDITERRANEAN GALLEY.
From a Model in the Museum of the Royal United Service Institution.
CHAPTER II
WAR CRAFT OF THE FAR WEST, CENTRAL AFRICA, THE FAR SOUTH,
THE PACIFIC, AND THE FAR EAST
Notwithstanding the enormous strides made in ship

construction, it is still possible to find in active use vessels but little
removed from the earliest types known. It is, of course, in the
“Mysterious East,” where anything that served its purpose very well
centuries ago seems to have been expected to retain its efficiency
for ever, that one finds those survivals from bygone ages. The
earliest vessels known were hollowed logs, or dug-outs; such are in
use still. Planks were stitched or lashed on above the bulwarks to
raise the freeboard and keep out the sea; the same contrivance is
applied to this day. A few strips of bamboo or other light material tied
together formed rafts; their exact counterparts are in existence in
many parts of the world. It was found possible to sail them by means
of a sail of matting attached to a yard which was supported by a
stout mast destitute of stays or standing rigging; a centre-board or
drop keel which could be lowered through the middle of the raft into
the water prevented leeway, and steering was effected by means of
a pole with a blade attached, usually tied on, this long paddle being
sometimes used near the middle of the after end of the raft and
sometimes at either of the after corners, the necessary leverage
being obtained by the provision of a stump for the purpose. The
origin of such rafts is lost in antiquity, yet they continue to be found in
active service.
The bark canoes which the Indians of North America employed on
the great rivers and lakes when white men first went there are
unchanged in their method of construction, and though in places
where civilisation and the mechanical arts have assumed sway the
old canoes have given way to the products of the modern boat-
builders’ skill, yet in the farther North-West the Indian canoe ripples
the summer surface of the lakes and streams as it did centuries ago.
The real Indian canoes were made by building the frame, and then
placing upon it a carefully prepared strip of birch bark sufficiently
large to cover the entire frame in one piece; it was lashed to the
frame and then stitched at the ends to form the bow and stern. The
larger canoes were sometimes stiffened by having two or three
pieces of wood lashed thwartwise. The canoes were propelled by
means of paddles, and the Indians sat or knelt on the bottom of the
boat. Many of these canoes weighed as little as 60 lb. and some
even less. Their chief use was in the migrations of the tribes
between their summer and winter quarters, and very picturesque
they must have appeared to the early settlers as a flotilla glided past;
that is, if an Indian could ever be regarded by an early settler as
anything but “pizen.” But these canoes served equally well to convey
the painted and feathered braves to battle; and anyone who has
seen the Indians in their canoes can well imagine how in days now
happily past, it is hoped for ever, a fleet of these boats, filled with
cruel and relentless men, passed swiftly and silently over the waters
at night, their paddles so skilfully wielded that the blades entered and
left the water with never a splash to break the solemn stillness. Then
the Indian canoe was no longer an emblem of joyous happiness,
made only for the sparkling waters and clear nights and days of that
foretaste of Paradise, the Indian summer, fit craft for the romantic
passing of Hiawatha to “the kingdom of Ponemah”; but an evil thing,
as swift and silent and terrible as the bloodthirsty men it bore to
victory or destruction.
WAR CANOES OF INDIANS OF THE NORTH-WEST.
From a Photograph of a Painting, supplied by the Curator of the Chicago Museum.
The skin canoe or kayak of the Eskimo holds only one person,
though its length may be anything from 7 or 8 feet to 25 feet. It is
simply a light frame, running to a fine point at either end, never more
than a few inches in depth, and with a breadth determined by the
breadth of the man who is to use it. It is entirely skin-covered, except
for a small hole in the deck, just abaft of amidships, in which the
solitary occupant sits. The Eskimo are very clever in the
management of their light craft—it weighs but a few pounds, and for
its size is probably the lightest sea-going vessel in the world—and
employ it chiefly in hunting, even at some distance from land.
The bark canoes of the Australian blacks were very primitive affairs;
they have almost disappeared, sharing the fate of the rapidly
dwindling aborigines. It may be doubted if a trace of one of these
canoes could now be found from one end of the Murray River to the
other. Since the blacks saw how easily the white man knocked
together a few planks and made a flat-bottomed, straight-sided boat,
they ceased to labour at bark canoes, but instead obtained a few
boards, usually by pilfering, “borrowed” or begged a few nails, and
with a stone for a hammer have done likewise, patching the very
leaky seams with anything that came handy, were it scrap of tin,
leather, raw hide, or well-greased fragment of a dirty, torn, old
blanket, and making up for deficiencies by incessant bailing. Never
again on the southern Australian rivers will the bark canoe convey
the braves to the scene of the tribal conflict, or ferry in the dying glow
of the setting sun the skeleton-painted men to the edge of the grim,
dark forest on the other shore to attend a great corroboree, whether
of war, rejoicing, or grief.
Nor have the African negroes made much progress beyond the dug-
out stage of war canoe construction. The Moors and Arabs long
since proved themselves excellent seamen and shipbuilders,
designing boats suitable to their needs, and are in quite another
category. The negroes of the Cross River district in Southern Nigeria
may be taken as typical of the African canoe makers. They usually
chose a mahogany or awosa tree, and, having felled it, burnt it
hollow where it fell. It was then dragged on rollers to the waterside
and finished with whatever tools were available, matchets, knives
and axes being used since the white man’s introduction of those
implements. Occasionally a canoe is “smoked” or hardened by being
exposed to the hot smoke of a fire built round it. Some of the war
canoes are as much as 60 feet in length, and are wide enough to
allow the men to sit two abreast. The larger ones have a steering
platform on a level with the gunwale or raised a foot or two above it,
and a smaller platform is placed at the bow, where a flagstaff may
also be fixed. When there are no thwarts or seats the crew sit on the
bottom of the canoe or on the gunwale, according to the size of the
vessel. Both bow and stern overhang. The paddles are made of
hardwood in one piece, 3 to 4 feet in length, and are pointed.
It is to the East Indies and the Pacific that we must turn to find the
most wonderful examples of the war canoe. They may be divided
into two classes: those with outriggers—this section including double
canoes—and those without.
A “DUG-OUT” CANOE OF NEW GUINEA.
NEW GUINEA CANOES WITH OUTRIGGERS.
From Photographs supplied by the Hon. J. E. Jenkins.
Many of the canoes lacked stability, even in calm waters, and the
risk of capsizing was greater in waters liable to sudden storms or
exposed to the ocean swell. To meet this difficulty and at the same
time permit of the continued use of the shallow harbours of their
coasts, the Malays are supposed to have invented the outrigger, and
this conjecture is based on the fact that wherever the Malay
influence is traceable there some form of the outrigger or double
canoe is to be found also.
The primitive hollowed log generally constitutes the hull of the
canoes of the Pacific Islanders. The rest is mainly a matter of
ornamentation. With but few exceptions, the islanders seem to have
believed that the higher and more imposing and ornamental they
could make the stems or sterns of their vessels, the more dreadful in
war were they likely to be. Many of these elevations are beautifully
carved; other canoes are merely grotesque, and not a few have no
artistic feature whatever to redeem them from absolute hideousness.
As a means of terrifying an enemy by presenting such things to his
astonished gaze they would doubtless be effective, had it not been
that the enemy would retaliate by presenting something equally ugly,
with the result that the moral effect which each party sought to
exercise upon the other would be neutralised. Some of the islanders
are said to have decorated the prows of their vessels with the skulls
of opponents killed in previous expeditions; while others contented
themselves with locks of human hair, similarly derived, as naval
adornments. With the exception of bows, arrows and spears, all their
weapons were designed for fighting at close quarters. It must have
been a labour of love, as well as a feeling of pride in the appearance
of the fearfully shaped and murderous clubs, which led them to carve
their weapons as carefully as they did, to render them so deadly, and
to adorn them with mother-of-pearl and sharks’ teeth. Not a few of
the paddles were given serrated edges in order that they could be
the more effectively employed as war clubs if necessary.
There are not many native war canoes now left in the South Seas.
None of the islanders, except the head-hunters, habitually kept
canoes for war purposes, though at times one would be designed
and built for some special expedition. The last of the great Samoan
war canoes has almost rotted to pieces on the shore. It is doubtful if
it has ever been used in a warlike expedition. It was between 60 and
70 feet in length, and 18 to 20 feet beam over all. It consisted of two
large single canoes, placed parallel a few feet apart, and joined by a
plank deck which ran across the greater part of the vessels.
Amidships was a house-like erection, used as a shelter. It was
propelled by oars, but also carried a mast and sails. It could easily
carry a hundred men.
The great canoe to hold three hundred men is but a memory; all that
is left of it is its steering paddle, 40 feet in length, which adorns the
wall in the Ethnographical section of the British Museum.
STEM-PIECE, MAORI WAR CANOE.
STERN-POSTS OF MAORI WAR CANOES.
From Examples in the Dominion Museum, Wellington, New Zealand.
A MAORI WAR CANOE.
From Angas’s “New Zealand.”
The canoes of that mysterious people, the Maori of New Zealand,
well repay attention in greater detail than is possible in this book.
The origin of the people themselves is unknown, though, if their
traditions are to be accepted, they migrated a few hundred years ago
from certain of the islands in the Central Pacific, partly conquered
and partly absorbed the people whom they found there already, and
have remained ever since. There has been more than one such
expedition. There are affinities between the Maori and the Hawaians.
Did the Maori come originally from Hawaii, or is there some
connection between them and the ancient Egyptians, as is held to be
indicated by certain points of resemblance in their carvings and
mural decorations? In what sort of canoes did they cross the ocean,
and how did they find their way? Unfortunately, the old chiefs who
held the traditions have all died, and it is only owing to the
painstaking researches of a few scholars who recognised the need
and value of preserving what could still be learnt, that anything at all
is known of the history of this strange people. Their legends tell us
that some of their canoes were of great size; some could carry fires
or places for cooking the food, and others were double canoes. One
of the latter is said to have had a platform connecting the two hulls,
and bearing a house; it was a three-masted vessel. All the New
Zealand canoes had names of symbolical or historical interest. One
of them was called Marutuahi, which, translated literally, means a
slaying or devouring fire.[8] The dimensions of the historical or
legendary canoes are not known. The straight, tall kauri pines of the
North Island enabled large canoes to be built; one is said to have
been 110 feet in length, and many of the later canoes were 60 to 80
feet long, and held a hundred to a hundred and fifty men. These
boats had long, overhanging bows ornamented with a figurehead
and two carved boards extending some little distance along either
bow. Between these boards and resting on the stem the carved
figurehead was placed and was often adorned with tufts of feathers.
A mast set rather far forward and raking aft supported a triangular
mat sail, the foot of which extended along the boom one and a half
times to twice the length of its height, and enabled the canoe to sail
very near the wind. The stays of the mast and the sheets of the sail
were of plaited flax. The drawbacks to these canoes were that
having no keels they made great leeway, and that their length made
them awkward to manage whenever they were caught in anything
like a rough sea; they could not meet the seas end on, but lay in the
trough of the waves, and were so well handled that disasters were
few. In rough weather they were covered with flax mats over a
portion of their length to prevent the seas breaking inboard.
The long pine hull was of great strength, but to render it more
seaworthy topsides were lashed along the sides of the hull from end
to end of the vessel with braids of flax fibres,[9] and the seams and
holes were caulked with a species of down. As a precaution against
leakage and to strengthen the joint, a long, thin batten was lashed
over the outside of the joint.
The decorations of the Maori canoes are wonderful. The spiral
pattern often seen in their carvings is taken from the unfolding of the
frond of a fern, and has been supposed to symbolise the unfolding of
life or the attainment of a planned enterprise. The greatest care and
the most artistic efforts were lavished upon the carvings of the prow
and stern boards. These boards were very large and always
removable. The log from which the stern-board was fashioned was
generally about 15 inches in diameter and 6 to 15 feet in length, and
in its complete state was covered with conventional and elaborate
patterns. The figurehead log was about 6 feet in length and 4 feet
wide, and 2 to 4 feet in thickness. Both were of hardwood and
coloured red with kokowai or ochre. If the figureheads represented
the dead chiefs who had joined the immortals in the Maori heaven,
they must have lost in the other world what little beauty was left to
them in this world after being tattooed. Not a few of the figures are
extraordinarily grotesque, and the weird effect of the red ochre is
heightened by the introduction of bright shiny eyes made of the inner
shell of the haliotis. Many also show the tattoo marks which were
supposed to add to Maori beauty, and most bore bunches of feathers
of the kaka and albatross, and on gala days were further adorned
with an elaborate and gaudy feather wig. The thin batten, already
alluded to, covering the join of the topside and hull, was always
stained black. Gannet feathers were inserted to cover the lashings
and contrasted vividly with the black batten and the reddened canoe.
The sides of many canoes also were painted in wavy lines of red,
white and black, as though in imitation of the wave motion.
Streamers of pigeon tail feathers hung from the top of the stern-
board to the water; even the sail point on the boom bore its tuft and
streamers of feathers.

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DIF: Cognitive Level: Apply (application) REF: 7

DIF: Cognitive Level: Apply (application) REF: 7

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DIF: Cognitive Level: Understand (comprehension) REF: 5

9. Which nursing diagnosis statement is written correctly?

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DIF: Cognitive Level: Apply (application) REF: 11

DIF: Cognitive Level: Apply (application) REF: 12

The order of the nurse’s statements follows the SBAR format.

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Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

VIKING SHIP FOUND AT GOKSTAD, SOUTH NORWAY.

What may be regarded as the first great national step in British

William the Conqueror’s fleet in the eleventh century is estimated at

WARSHIPS OF THE FOURTEENTH CENTURY.

Notwithstanding the enormous strides made in ship

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