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5. 2
Copyright © 2019 Pearson Education, Inc.
2) The nurse is assessing a patient's risk factors for disease at an annual physical examination.
Which question would the nurse ask to assess lifestyle risk factors?
A) "Does your neighborhood have parks and sidewalks?"
B) "Tell me about the health of your parents."
C) "What is the highest level of education that you completed?"
D) "How would you describe your diet?"
Answer: D
Explanation: A) Risk factors emerge from a number of sources. One is the genetic blueprint
provided to each of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions
about diet, exercise, smoking, and other variables that influence health. Social determinants of
health are factors related to where one lives, educational level, income, availability of fresh food,
public transportation, and a number of other considerations that can affect health.
B) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
C) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
D) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
Page Ref: 9
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.2 Describe characteristics of
and risk factors associated with health and illness. | QSEN Competencies: I.B.10 Engage patients
or designated surrogates in active partnerships that promote health, safety and well-being, and
self-care management | AACN Essential Competencies: IX. 1. 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

6. 3
Copyright © 2019 Pearson Education, Inc.
3) The occupational health nurse is assessing a manufacturing plant for chemical agents that may
cause disease in the employees. The nurse should be alert for:
A) stress levels.
B) helminths.
C) radiation.
D) lead.
Answer: D
Explanation: A) Endogenous disease etiologies arise from within the body. Examples are
abnormal immune reactions, gene mutations, coagulation defects, stress, and metabolic
abnormalities.
B) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of infectious etiologic agents are bacteria,
viruses, fungi, and helminths.
C) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of physical etiologic agents are extremes in
environmental temperatures, radiation, trauma, and electricity.
D) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of chemical etiologic agents are alcohol,
lead, mercury, air pollutants, carbon monoxide, pesticides, and adverse effects of medications.
Page Ref: 10
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX. 1. 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

7. 4
Copyright © 2019 Pearson Education, Inc.
4) A patient has been diagnosed with idiopathic pulmonary fibrosis. The nurse explains to the
patient that idiopathic means:
A) the disease is inherited.
B) the cause is unknown.
C) it was caused by an error in care.
D) the disease is secondary to another illness.
Answer: B
Explanation: A) A disease that is inherited is a genetic or hereditary disorder.
B) When the cause of a disease cannot be determined, its etiology is said to be idiopathic.
C) The etiology of conditions that are caused unintentionally by a treatment, a diagnostic
procedure, or an error caused by a healthcare provider are called iatrogenic.
D) A condition that is caused by another disease is called a secondary disorder.
Page Ref: 10
Cognitive Level: Understanding
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

8. 5
Copyright © 2019 Pearson Education, Inc.
5) The nurse is documenting the assessment findings from a patient being seen in the clinic.
Which of the following does the nurse document as a subjective finding?
A) Nausea
B) Breath sounds
C) Fever
D) Skin color
Answer: A
Explanation: A) A symptom is a subjective sensation that is perceived by the affected individual
but not observable by the person examining the individual. Examples of symptoms include pain,
nausea, dyspnea, and numbness. A sign is an objective indication of disease that is observable by
the person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
B) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
C) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
D) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
Page Ref: 10
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Assessment | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX. 1. 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

9. 6
Copyright © 2019 Pearson Education, Inc.
6) How should the nurse respond when a patient asks the difference between acute and chronic
hip pain?
A) "An acute illness develops over a longer period of time than a chronic one."
B) "A chronic illness is more serious than an acute illness."
C) "A chronic illness is enduring while an acute illness is short term."
D) "A chronic illness is life threatening while an acute illness is not."
Answer: C
Explanation: A) An acute injury or disease is one that appears quickly; a chronic condition has
an enduring quality with lasting implications. An important point is that neither of these terms
relates to severity or degree of injury or disease. For example, when an individual sprains an
ankle, an acute injury, the injury is sudden but might not have significant lasting implications. In
contrast, with a chronic disease, there are several states that may be enduring and lasting (such as
a mild case of osteoarthritis) but without significant impairment of functional ability.
B) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
C) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
D) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
Page Ref: 11
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

10. 7
Copyright © 2019 Pearson Education, Inc.
7) A nurse researcher involved in epigenomics is studying:
A) the role of specific genes.
B) the function of groups of genes in mediating physiologic function.
C) genetic variations and modifications that influence a particular cell.
D) the origin of the structural and functional events leading to disease.
Answer: C
Explanation: A) Through genetics, the role of specific genes is studied. This study involves
examining how genetic variations are passed through familial inheritance.
B) Genomics refers to the study of the function of groups of genes in terms of mediating
physiologic function. Genomics studies how an inherited genetic trait, such as sickle cell trait,
influences the likelihood that an individual will develop sickle cell disease.
C) The study of all genetic variations or modifications that have influenced a particular cell is
referred to as epigenomics. The focus is on the broader picture in terms of studying a complete
set of modifications to cellular DNA.
D) The pathogenesis of a disease refers to origin of, or the underlying mechanisms responsible
for, the clinical manifestations of that disease. Pathogenesis is the origin of the sequence of
events to structural and/or functional alterations in cells, tissues, or organs resulting in disease.
Page Ref: 10-11
Cognitive Level: Understanding
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.B. 1 Participate
effectively in appropriate data collection and other research activities | AACN Essential
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: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

11. 8
Copyright © 2019 Pearson Education, Inc.
8) When planning a program to educate the community about healthy nutrition, the community
health nurse should tell adults to consume:
A) 100% of grain intake as whole grains.
B) at least 3.5 cups of fruits and vegetables each day.
C) more highly pigmented fruits and vegetables.
D) 3 to 5 servings of dairy each day.
Answer: C
Explanation: A) At least half of our daily intake of grains should be whole grains. The words
"whole wheat" as the first ingredient indicates a whole grain product. Other good choices are
common foods as oatmeal and popcorn. Less familiar grains such as quinoa or whole-grain
couscous could also be included.
B) Adults are advised to consume at least 4.5 cups of fruits and vegetables daily for a variety of
vitamins, minerals, phytochemicals, and fiber.
C) The more highly pigmented the fruits and vegetables are, the better. Beets, spinach, squash,
and berries are all good picks.
D) Most Americans should consume two to three servings of low-fat dairy foods such as milk,
yogurt, or low-fat cheese daily.
Page Ref: 12
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | AACN Essential Competencies: VII. 11. Participate in clinical prevention and
population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness
and equity
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

12. 9
Copyright © 2019 Pearson Education, Inc.
9) When developing a care plan to teach a patient with hypertension about sodium intake, the
nurse should include limiting sodium intake to:
A) 2,300-2,500 mg/day.
B) 2,000-2,300 mg/day.
C) 1,500-2,000 mg/day.
D) less than 1,500 mg/day.
Answer: D
Explanation: A) Sodium should be limited to 2,300 mg/day for individuals younger than 51
years of age and less than 1,500 mg/day for those 51 years of age or older, African Americans,
and individuals with hypertension, diabetes, or chronic kidney disease.
B) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
C) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
D) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
Page Ref: 13
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

13. 10
Copyright © 2019 Pearson Education, Inc.
10) Which of the following statements describes the role of a nurse involved in epidemiology?
A) The nurse studies an individual's risk for disease.
B) The nurse provides care to individuals with certain diseases.
C) The nurse studies the distribution of disease in a population.
D) The nurse provides care to a population.
Answer: C
Explanation: A) Epidemiology is broadly defined as the study of how disease is distributed in
populations and identification of the factors influencing the distribution.
B) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
C) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
D) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
Page Ref: 14
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII.1 Assess protective and predictive factors, including
genetics, which influence the health of individuals, families, groups, communities and
populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

14. 11
Copyright © 2019 Pearson Education, Inc.
11) Which statement represents the epidemiology nurse's calculation of the incidence of asthma?
A) There were 10 new cases of asthma diagnosed in adults ages 24 to 65 years in the past 12
months in Centerville.
B) There were a total of 3,600 people with a diagnosis of diabetes in Centerville in 2015.
C) There were 2 people diagnosed with Lyme disease in Centerville last year.
D) There were 20 cases of opioid overdose in adults ages 18 to 24 years in Centerville.
Answer: A
Explanation: A) Incidence is the number of new cases of a condition within a defined period and
for a defined population, such as the number of individuals who experienced a spinal cord injury
within the past 12 months in the United States. Other defined populations could include adults,
children, and athletes. Incidence provides a sense of frequency of occurrence in a particular
group or population. Prevalence is the number of individuals of a defined population who
already have a disease or condition, such as the number of adults in the United States with a
spinal cord injury.
B) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
C) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
D) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
Page Ref: 14
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII. 11. Participate in clinical prevention and population-
focused interventions with attention to effectiveness, efficiency, cost-effectiveness and equity
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

15. 12
Copyright © 2019 Pearson Education, Inc.
12) In developing a plan for teaching community health nurses about the role of the nurse in
epidemiology, the epidemiology nurse should include:
A) diagnosing the cause of a disease.
B) treating the disease.
C) evaluating therapeutic measures.
D) reducing risk factors for disease.
Answer: C
Explanation: A) The objectives of epidemiology are to identify the cause of the disease and the
risk factors, to determine the extent of the disease in the community, to study the natural history
and the prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
B) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
C) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
D) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
Page Ref: 14
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII.1 Assess protective and predictive factors, including
genetics, which influence the health of individuals, families, groups, communities and
populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

16. 13
Copyright © 2019 Pearson Education, Inc.
13) When planning community health promotion and prevention programs, the nurse should be
aware that the leading cause of death in the United States is:
A) accidents.
B) suicide.
C) heart disease.
D) cancer.
Answer: C
Explanation: A) The leading causes of death in the United States in 2015 were: heart disease
614,348; cancer (all forms) 591,699; chronic lower respiratory diseases 147,101; accidents
(unintentional injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease
93,541; diabetes 76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and
nephrosis 48,146; and intentional self-harm (suicide) 42,773.
B) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
C) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
D) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
Page Ref: 15
Cognitive Level: Understanding
Client Need & Sub: Health Promotion and Disease Prevention
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | AACN Essential
Competencies: VII.1 Assess protective and predictive factors, including genetics, which
influence the health of individuals, families, groups, communities and populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

17. 14
Copyright © 2019 Pearson Education, Inc.
14) Which information about risk factors should the school nurse use when developing a
program to reduce modifiable risk factors in high school students?
A) Sickle cell anemia is an inherited disorder.
B) Heart disease develops at an earlier age in men.
C) Many high school students do not get enough physical activity.
D) Certain ethnic variables increase the risk for chronic disease.
Answer: C
Explanation: A) Age, gender, and racial/ethnic differences are unmodifiable risk factors for
many diseases.
B) Age, gender, and racial/ethnic differences are unmodifiable risk factors for many diseases.
C) The four most important modifiable health risk behaviors are physical inactivity, poor
nutrition, tobacco use, and excessive alcohol consumption. Only 33% of U.S. high school
students participate in daily physical education classes.
D) Age, gender, and racial/ethnic differences are unmodifiable risk factors for many diseases.
Page Ref: 15-16
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | AACN Essential
Competencies: VII.1 Assess protective and predictive factors, including genetics, which
influence the health of individuals, families, groups, communities and populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

18. 15
Copyright © 2019 Pearson Education, Inc.
15) A woman with type 1 diabetes is being seen for her first prenatal examination. Which
information should the nurse include in the woman's care plan?
A) Teaching the signs and symptoms of preeclampsia
B) Explaining the fetal risk of microsomia
C) Discussing symptoms of placental abruption to report
D) Reinforcing that there will be no risk to the fetus
Answer: A
Explanation: A) Women who had type 1 or type 2 diabetes before becoming pregnant can have
a variety of adverse fetal and maternal outcomes, such as increased risk for preeclampsia,
hypertension during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery,
macrosomia (very large baby), hypoglycemia, fetal death, and infant death.
B) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
C) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
D) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
Page Ref: 16
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

19. 16
Copyright © 2019 Pearson Education, Inc.
16) A nurse working on a busy medical unit has noticed an increase in the incidence of pressure
ulcers in the patient population. Which action demonstrates the principles of evidence-based
practice (EBP)?
A) Reviewing the literature for current best evidence pressure ulcer prevention
B) Reviewing the literature for informational articles on best methods to prevent pressure ulcers
C) Reviewing hospital policy and procedures to make sure they are being followed correctly
D) Reviewing patient charts to audit nursing interventions to prevent pressure ulcers
Answer: A
Explanation: A) EBP is "the conscientious, explicit and judicious use of current best evidence in
making decisions about the care of the individual patient. It means integrating individual clinical
expertise with the best available external clinical evidence from systematic research."
B) EBP should be based on research and best evidence and not informational articles.
C) Policy and procedures may not reflect the most current EBP. They should be reviewed to
determine if they are based on current best evidence.
D) Auditing nursing care is not an example of EBP.
Page Ref: 17
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.5 Explain the importance of
evidence-based practice. | QSEN Competencies: III.A. Demonstrate knowledge of basic
scientific methods and processes | AACN Essential Competencies: IX.8. Implement evidence-
based nursing interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

20. 17
Copyright © 2019 Pearson Education, Inc.
17) Which action by the nurse shows an understanding of integrating evidence-based principles
into practice?
A) Creating a care plan and then presenting it to the patient
B) Making the best decisions for the patient
C) Seeking patient preferences about his care
D) Providing written information explaining the patient's care
Answer: C
Explanation: A) The process of implementing evidence into practice relies on melding clinical
expertise with existing research evidence in providing care that also respects the values and
preferences of the patient. Without acknowledging patient preferences and experience, the
healthcare provider could implement interventions supported by the literature but find a patient
who is not adhering to the recommendations because of different goals or values.
B) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
C) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
D) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
Page Ref: 17
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.5 Explain the importance of
evidence-based practice. | QSEN Competencies: III.A. Demonstrate knowledge of basic
scientific methods and processes | AACN Essential Competencies: IX.8. Implement evidence-
based nursing interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

21. 18
Copyright © 2019 Pearson Education, Inc.
18) When developing a care plan for a patient with asthma, the nurse needs to understand which
pathophysiological subconcept?
A) Infection
B) Coagulation
C) Inflammation
D) Perfusion
Answer: C
Explanation: A) Asthma is a condition of reactive airway constriction, in which parts of the
respiratory tract are sensitive to allergens. In the presence of an environmental allergen, parts of
the respiratory tract constrict, restricting the flow of air into the lung. The reduction in air flow
leads to decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the
immune system, which releases inflammatory mediators. The resulting inflammation contributes
to the reduction of airflow.
B) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
C) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
D) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
Page Ref: 7
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Planning | Learning Outcome: 1.1 Define the conceptual basis for
and the language used in the study of pathophysiology. | QSEN Competencies: III.A.1.
Demonstrate knowledge of basic scientific methods and processes | AACN Essential
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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

22. 19
Copyright © 2019 Pearson Education, Inc.
19) When the nurse teaches parents how transmitting the sickle cell trait to offspring influences
the development of sickle cell disease, the nurse is applying principles of:
A) genomics.
B) genetics.
C) epigenomics.
D) gene.
Answer: A
Explanation: A) Genomics refers to the study of the function of groups of genes in terms of
mediating physiologic function. Genomics explains how an inherited genetic trait, such as sickle
cell trait, influences the likelihood that an individual will develop sickle cell disease.
B) Genetics is the study of how gene variations are passed through familial inheritance.
C) Epigenomics is the study of all genetic variations or modifications that have influenced a
particular cell. The focus is on the broader picture in terms of studying a complete set of
modifications to cellular DNA.
D) Genes, made up of DNA, are the genetic material of inheritance within a cell.
Page Ref: 11
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | 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: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

23. 20
Copyright © 2019 Pearson Education, Inc.
20) The nurse is reviewing literature to determine the death rate due to cardiovascular disease in
the United States. The nurse understands that the information he is seeking indicates:
A) morbidity.
B) mortality.
C) disability-adjusted life-years.
D) prevalence.
Answer: B
Explanation: A) Morbidity is defined as a departure from physiologic or psychologic well-being
and encompasses disease, injury, and disability.
B) Mortality is defined as the number of deaths in a given population.
C) Disability-adjusted life-years (DALYs) are defined as the years of potential life lost due to
premature mortality and the years of productive life lost due to disability for people living with
the health condition or its sequelae.
D) Prevalence is the number of individuals of a defined population who already have a disease or
condition.
Page Ref: 14-15
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and
processes | AACN Essential 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: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

24. Another random document with
no related content on Scribd:

25. — Antakoon tämä talo meille ilon päiviä!
Kmicic tuli vilkaisseeksi ympärilleen ja huomasi vanhuuttaan
mustuneilla honkaisilla seinillä joukon ankaria katseita, jotka olivat
suunnatut häneen. Nämä katseet tuijottivat vanhoista Billewiczien
muotokuvista, jotka olivat ripustetut vain parin kolmen kyynärän
korkeuteen lattiasta, sillä huone oli matala. Muotokuvien yläpuolella
oli jono hirvien ja petoeläinten kalloja, toiset mustuneita, mutta toiset
valkeuttaan loistavia. Kaikki neljä seinää oli koristettu samaan
tapaan.
— Täällä näyttää olevan hyvät metsästysmaat ja petoja runsaasti,
—virkkoi Kmicic.
— Huomenna tai ylihuomenna lähdemme katsomaan. Pitää
tutustua ympäristöönkin, — arveli Kokosinski. — Sinä olet
onnellinen, Jendrus,sillä sinulla on mihin pääsi kallistat!
— Sinulla on toisin kuin meillä, — huokasi Ranicki.
— Juokaamme surut pois! — esitti Rekuc.
— Ei! — vastasi Kulwiec-Hippocentaurus. — Nyt juomme vielä
Jendruksen, meidän rakastetun ratsumestarimme terveydeksi! Juuri
hän, hyvät herrat, on ottanut tänne Lubicziin hoteisiinsa meidät,
kodittomat pakolaiset.
— Hyvin sanottu! — huusivat muutamat. — Tuo Kulwiec ei ole niin
typeräkuin miltä hän näyttää.
— Kova on kohtalomme, — valitti Rekuc. — Toivomme, että sinä
et ajapellolle meitä poloisia.

26. — Heretkää! — virkkoi Kmicic. — Mikä on minun, se on teidänkin!
Tämän kuultuaan kaikki karkasivat paikoiltaan syleilemään
isäntää. Malja seurasi maljaa. Kaikki puhuivat yht'aikaa, eikä kukaan
kuunnellut muuta kuin omaa itseään, lukuunottamatta herra Rekucia,
joka näytti uinailevan pää painuneena rinnalle. Kokosinski pisti
lauluksi, jaherra Uhlik otti povesta tshekanikkansa, jolla alkoi
säestää. Muttamiekkailumestari Ranicki miekkaili paljaalla kädellään
näkymättömänvastustajan kanssa hokien puoliääneen:
— Sinä noin, mutta minä näin, sinä tänne, minä tuonne… Yks,
kaks,kolme — noin!
Jättiläinen Kulwiec-Hippocentaurus avasi silmänsä selko selälleen
ja katseltuaan jonkin aikaa tarkkaavasti Ranickin temppuja huitaisi
kädellään sanoen:
— Sorki mitä sorkit, mutta Kmicicin kanssa et vetele vertoja
miekanmittelössä.
— Eikä kukaan muukaan. Koetapas itse.
— Pistolillakaan et ammu niin kuin minä.
— Dukaatti vetoa!
— Olkoon menneeksi! Mutta missä ja mihin? Ranicki silmäili
ympärilleenja huusi osoittaen pääkalloa seinällä:
— Sarvien väliin! Dukaatti murskaksi!
— Mikä hätänä? — kysyi Kmicic.
— Sarvien väliin! Kaksi dukaattia! Kolme! Antakaa pistoli!

27. — Kiinni on! — huusi herra Andrzej. — Kolme dukaattia! Zend!
Pistolit!
He alkoivat yhä äänekkäämmin lyödä veikkaa. Sillävälin käväisi
Zendeteisessä tuoden pistolit, pussillisen kuulia ja ruutisarven.
Ranicki sieppasi pistolin.
— Onko ladattu? — kysyi hän.
— On.
— Kolme dukaattia! Neljä! Viisi dukaattia! — huusi humaltunut
Kmicic.
— Hiljaa! Ohi ammut!
— Ohiko? Katsopas!… Tuohon kalloon tuolla, sarvien väliin… Yks,
kaks…
Kaikki tuijottivat suureen hirvenkalloon, joka riippui vastapäätä
Ranickia. Ampuja kohotti kätensä… se vapisi…
— Kolme! — kirkaisi Kmicic.
Laukaus pamahti ja huone täyttyi ruudinsavulla.
— Ohi, ohi! Tuolla on reikä! — huusi Kmicic osoittaen
mustuneeseenseinään, johon kuula oli viiltänyt valkoisen jäljen.
— Vielä kaksi laukausta!
— Ei! Pistoli tänne! — huusi Kulwiec. Samassa syöksyi pelästynyt
palvelusväki huoneeseen.

28. — Ulos! Ulos!-ärjyi Kmicic.-Yks, kaks, kolme!
Taas pamahti laukaus, mutta tällä kertaa lensi pääkallon siruja
halkiilman.
— Antakaa meillekin pistolit! — huusivat muut kuin yhdestä
suusta.
Neljännestunnin kuluttua kajahteli huoneessa laukaus toisensa
jälkeen. Savu himmensi valon ja ampujain ääriviivat. Laukausten
paukkeeseen yhtyi Zendin ääni; tämä rääkkyi kuin varis, ulvoi kuin
susi, mörisi kuin metsähärkä. Ilmassa lenteli luunsiruja pääkalloista,
lastuja seinistä ja palasia muotokuvien kehyksistä. Hälinässä
ammuttiin Billewiczeihinkin, ja Ranicki, joka sai raivokohtauksen,
alkoi huitoaniihin miekalla.
Säikähtynyt palvelusväki mulkoili pelon puistattamana tätä villiä
leikkiä, joka muistutti tataarien hyökkäystä. Koirat alkoivat haukkua
ja ulvoa. Koko talo oli jalkeilla. Pihalle kokoontui ihmisiä.
Palvelustyttöjä juoksi ikkunan alle ja painaen kasvonsa ruutuihin
kiinni, niin että nenät litistyivät, tirkistelivät he sisälle nähdäkseen
mitä savuisessa huoneessa tapahtui.
Vihdoin Zend äkkäsi heidät ja kiljahti niin vihlovasti, että kaikkien
korvat olivat mennä lukkoon.
— Hyvät herrat! Lintusia! Ikkunan takana on lintusia!
— Lintusia! Lintusia!
— Tanssimaan!

29. Ja juopunut joukko ryntäsi pihamaalle. Pakkanen ei jäähdyttänyt
kuumia päitä. Tytöt kiljuen ja kirkuen pakenivat mikä minnekin. Mutta
sotaveikot painoivat jäljessä ja toivat sisälle huoneeseen jokaisen,
jonka kiinni saivat. Kohta alkoi karkelo keskellä savua, siruja,
sirpaleita tuon suuren pöydän ympärillä, jolta viini virtasi.
Näin juhlivat Lubiczissa herra Kmicic ja hänen hurjat
kumppaninsa.

30. KOLMAS LUKU.
Seuraavina päivinä herra Andrzej kävi tuon tuostakin Wodoktyssa
palaten sieltä joka kerta yhä rakastuneempana ja yhä
ihastuneempana omaan Oleńkaansa. Tovereitten kuullen hän ylisti
neitostaan aina taivaaseensaakka. Eräänä päivänä hän sanoi heille:
— Rakkaat kuomaseni, tänään teidän tulee käydä tervehdyksellä
Wodoktyssa, sillä sitten me lähdemme kaikki yhdessä katsomaan
kolmatta maatilaa Mitrunyssa. Hän ottaa meidät kyllä
vieraanvaraisesti vastaan, mutta muistakaa käyttäytyä säädyllisesti,
muuten survon teidätsilpuksi…
Kavaljeerit riensivät halukkaasti siistimään itseään, ja pian neljä
rekeä kiidätti elämänhaluista nuorta väkeä Wodoktyyn. Herra Kmicic
istui ensimmäisessä reessä, joka oli sangen komea ja karhun
muotoinen. Sen edessä oli kalmukkilainen kolmivaljakko, jonka
valjaat oli koristettu kirjavilla nauhoilla ja riikinkukon sulilla, kuten
Smolenskissa oli tapana. Hevosia ohjasi tallipoika, joka istui karhun
kaulalla. Herra Andrzejn yllä oli vihreät, kullanvärisillä nauhuksilla
koristetut ja soopelinnahalla reunustetut samettiturkit ja päässä
soopelinnahkainen lakki, jossa oli haikaransulka. Hän oli hyvällä

31. tuulella, innostunut ja puheli vieressään istuvalle Kokosinskille tähän
tapaan:
— Kuulehan, Kokoszko! Me olemme remunneet aika lailla näinä
parina iltana, etenkin ensimmäisenä, jolloin pääkallot ja
muotokuvatkin saivat osansa. Pahinta tässä on se tyttöjen juttu. Aina
se pahuksen Zend keksiikin jos jotakin, ja kuka tästä sitten saa
vastata, jollen minä! Pelkään, että ihmiset saavat kuulla, ja maineeni
joutuu vaaraan.
— Mene hirteen maineinesi, sillä ei se mihinkään muuhunkaan
kelpaa,enemmän kuin meidänkään maineemme!
— Mutta kenen syy, jollei teidän. Muistapas vain, Kokoszko, että
Orszassa minä teidän tähtenne sain pahan maineen, minkä tähden
minuahaukuttiin ja pisteltiin.
— Entä kuka raastoi herra Tumgratia pakkasessa hevoseen
sidottuna? Jakuka tappoi virkamiehen, joka kysyi: käydäänkö
Orszassa jo kahdella jalalla vaiko neljällä vielä? Kuka piteli
Wyzinskeja niin pahasti, ettähaavoja saivat? Kuka hajoitti maapäivät
Orszassa?
— Maapäivät minä hajoitin, mutta se on orszalaisten ja minun
välinen asia. Herra Tumgrat antoi minulle anteeksi, ennenkuin heitti
henkensä, ja mitä muuhun tulee, niin sanon, että viattominkin voi
joutuakaksintaisteluun.
— Enpä ole vielä luetellut kaikkia syntejäsi; sotaoikeudessakin
sinuakaksi juttua odottaa.

32. — Ei minua, vaan teitä, sillä vain sen verran on minussa syytä,
että annoin teidän vorota rauhallisia kansalaisia. Mutta mitäpä
tuosta! Muista pitää kitasi kiinni, Kokoszko, ja olla Oleńkalle mitään
virkkamatta niin kaksintaisteluista kuin muotokuvien pommituksesta
ja tytöistä. Jos jotakin käy ilmi, työnnän syyn teidän niskoillenne.
Väelle olen jo sanonut ja tytöille myöskin, että niskat nitistän nurin,
jos hiiskuvat sanallakaan.
— Mene suohon, Jendrus, koska noin neitoasi pelkäät! Orszassa
sinä olitaivan toisenlainen. Näenpä jo surullisen loppusi, kuinka sinä
kiltistitulet kulkemaan talutusnuorassa.
— Typeryyksiä latelet, Kokoszko! Mutta mitä Oleńkaan tulee, niin
saatpa nähdä, ettet tiedä, miten pysyt jaloillasi hänet nähdessäsi,
sillä sellaista naista et ole ikänäsi tavannut. Mikä hyvää on, sitähän
ylistää, mutta mikä on pahasta, sen hän tuomitsee; hänen omat
hyveensä ovat hänen mittapuunsa, ja sellaiseksi on everstivainaja
hänet kasvattanut. Jos sinä hänen edessään päästät ritarillisen
mielikuvituksesi valloilleen ja innostut kehaisemaan rikkoneesi lakia,
niin häpeälle joudut, sillä hän sanoo siihen heti, että niin ei saa
kunnon kansalainen menetellä, koska se on turmioksi isänmaalle…
Niin hän sanoo, ja sinusta tuntuu kuin olisit saanut vasten kuonoasi,
ja ihmettelet, ettet ennemmin ollut sitä käsittänyt… Hyi olkoon,
kuinka olemme eläneet, ja nyt meidän täytyy katsoa itse hyvettä ja
viattomuutta suoraan silmiin… Pahinta ovat ne tytöt…
— Eikös mitä, eivät ne niinkään pahinta olleet. Mutta kuulin, että
lähiseudun taloissa pitäisi olla sellaisia tyttäriä kuin hunaja jamesi…
eikä pahasti äksyjä.
— Kuka niin sanoi? — kysyi Kmicic innokkaasti.

33. — Kukako sanoi? Kukas muu kuin Zend? Ajaessaan eilen
koetteeksi hevosta hän joutui Wolmontowiczeen, jossa tapasi joukon
»lintusia», jotka olivat menossa iltamessusta kotiin. »Luulin
putoavani hevosen selästä», — sanoi, — »niin suloisia ja sieviä
olivat». Ja ketä katsoikin, seheti nauroi hänelle hampaita välkytellen.
Eikä ihmekään: ovathan pojat kaikki poissa, sodassa, ja »lintuset»
ikävissään yksikseen.
Kmicic tökkäsi nyrkillä toveriaan kylkeen:
— Kuulehan, Kokoszko, emmekö lähde joskus illalla… muka
eksyneinä…mitä?
— Entä sinun maineesi?
— Senkin vietävä! Tuki turpasi! lähtekää hiidessä ilman minua, jos
sikseen tulee… tai ehkä on parempi, että ette lähde lainkaan! Teette
kuitenkaan voisi olla rymyämättä, ja minä tahdon elää sovussa
täkäläisten aatelisten kanssa, jotka everstivainaja on määrännyt
Oleńkan holhoojiksi.
— Niin, sinä olet maininnut siitä minulle, mutta minä en sitä ottanut
uskoakseni. Mistä sellainen luottamus?
— Hän on käynyt heidän kanssaan sotia, ja Orszassa minä jo
kuulin häneltä itseltään, että nämä laudalaiset ovat oivallista väkeä.
Totta puhuen, minä itsekin ensin sitä ihmettelin; oli kuin hän olisi
tahtonutmäärätä heidät pitämään minua silmällä.
— Mitäpä tehdä? Saat nöyrästi kumartaa heille.
— Suus kiinni! Sitä en tee ikänä!… Kumartakoot he minulle ja
totelkoot komennustani!

34. — Joku muu tulee heitä komentamaan. Zend kertoi, että täällä on
muuan eversti, josta kuuleman mukaan tulee lippukunnan
päämies… Mikäs hänen nimensä olikaan?… Wolodyjowski se taisi
olla. Hän on johtanut heitä jo Szklowin luona, lujasti olivat otelleet,
mutta selkään olivatkuitenkin saaneet.
— Olen kuullut puhuttavan eräästä Wolodyjowskista, kuuluisasta
soturista… Kas tuollapa Wodokty jo näkyy!
— Hyvä näyttää ihmisten täällä Samogitiassa olevan, koska
kaikkialla on niin ankara järjestys. Ukko lienee ollut kova
maanviljelijä. Komea onpäärakennuskin. Vihollinen polttaa täällä
harvoin, niin että kelpaahansitä sitten rakennella.
— Luulen, ettei hän tiedä mitään hurjastelustamme Lubiczissa, —
arveli
Kmicic ikäänkuin itsekseen.
Sitten hän kääntyi naapurinsa puoleen:
— Kokoszko, muista sanoa muille, että käyttäytyvät arvokkaasti.
Joka vähääkään liikoja puhuu, sen minä, niin totta kuin Jumala on
pyhä,säpäleiksi silvon.
— Oletpas sinä joutunut pahaan asemaan.
— Olen tai en, se ei ole sinun asiasi. Poika, hoi! Ammu!
Karhun hopeoidulla kaulalla istuva tallipoika ampua paukahdutti,
muut ajopojat seurasivat esimerkkiä, ja reet ajoivat iloisessa
hälinässäpihalle.

35. Tulijat astuivat suureen eteiseen ja sieltä ruokasaliin, jonka seinät
oli, samoinkuin Lubiczissa, koristettu petojen pääkalloilla. Täällä he
odottivat katsoen tarkasti ja uteliaasti oveen, josta Aleksandra-neidin
piti tulla. Kaikesta päättäen olivat Kmicicin varoitukset heillä
tuoreessa muistissaan, koska he juttelivat hiljaa kuin kirkossa.
— Sinä puhut kauniisti… — kuiskasi herra Uhlik Kokosinskille. —
Tervehdipäs sinä häntä meidän kaikkien puolesta.
— Ajattelin kyllä matkalla sanoja tervehdykseksi, — vastasi siihen
herra Kokosinski, — mutta en tiedä, miten sujuvasti saan ne
sanotuksi,sillä Jendrus häiritsi minua.
— Rohkeasti vain, niin hyvin käy! Tuossa hän jo tuleekin.
Neiti Billewicz tuli todellakin, mutta pysähtyi kynnykselle, ikäänkuin
hän olisi hämmästynyt vieraitten paljoutta. Herra Kmicicin löi tulijan
kauneus kuin salama; hän oli, näet, nähnyt Oleńkan vain illoin, mutta
päivän valossa oli neitonen vieläkin kauniimpi. Hänen silmissään oli
ruiskaunokin sineä, mustat kulmakarvat erottautuivat kirkkaasti
valkoisesta otsasta, ja vaalea tukka loisti kuin kruunu kuningattaren
päässä. Rohkeasti, katsettaan alas luomatta, kuten kunnianarvoinen
emäntä ainakin, hän vastaanotti vieraansa silmäillen säteilevästi
ympärilleen; hänen vaikutustaan lisäsi vielä musta puku. Noin ylevää
ja loistavan kaunista neitiä eivät soturit vielä milloinkaan olleet
nähneet — he olivat tottuneet toisenlaisiin tyttöihin — ja
senpätähden he rivissä seisoen ja kantapäitään kopahduttaen
kumarsivat syvään jaikäänkuin komennon mukaan. Herra Kmicic
astui neidin luo, suuteli kättäja sanoi:
— Tässä, minun aarteeni, ovat asetoverini, joiden kanssa olen
kamppaillut viimeisessä sodassa.

36. — Minulle on suuri kunnia, — vastasi neiti Billewicz, — saada
vastaanottaa talooni niin uljaita ritareja, joitten jalosta syntyperästä
olen jo kuullut herra lipunkantajalta.
Tämän sanottuaan neiti kohautti hyppysillään hamettaan ja
kumarsi mitä suurimmalla arvokkuudella. Herra Kmicic puri huultaan,
mutta iloitsi samalla siitä, että hänen neitosensa oli uskaltanut puhua
niinrohkeasti.
Jalot ritarit yhä kumartelivat kantapäitään kopahduttaen ja
työntäen
Kokosinskia kylkeen:
— Astu esiin, astu esiin…
Herra Kokosinski astui askelen eteenpäin, rykäisi ja alkoi:
— Jalosukuinen neiti! En tiedä mitä minun tulee koko orszalaisen
lippukunnan nimessä enemmän ylistää, armollisen neidin kauneutta
ja hyväsydämisyyttäkö vaiko meidän ratsumestarimme ja
asetoverimme herra Kmicicin osaksi tullutta sanomatonta onnea,
sillä vaikkapa hän nousisi pilviin saakka, kohoaisi pilvien… minä
tarkoitan, ihan pilviinsaakka…
— Astuhan nyt jo alas niistä pilvistä! — huudahti Kmicic.
Ritarit purskahtivat raikuvaan nauruun, mutta muistettuaan
samassa
Kmicicin varoituksen nostivat kämmenensä suun eteen.
Herra Kokosinski hämmentyi kokonaan, punastui ja sanoi:
— Puhukaa itse, senkin pakanat, koska kerran minua häiritsette!

37. Aleksandra-neiti kohautti taas hyppysillään hamettaan:
— Minä en kykenisi vastaamaan teille niinkuin pitäisi, mutta sen
tiedän, etten ansaitse niitä ylistyksiä, joita te esiintuotte minulle koko
orszalaisen lippukunnan nimessä, — sanoi hän ja kumarsi taas
erinomaisen arvokkaasti.
Orszalaiset kavaljeerit tunsivat asemansa hieman kiusalliseksi
tämän hovitapoja taitavan neidin edessä. He koettivat olla niinkuin
kaikki olisi hyvin, mutta se ei oikein onnistunut. Toiset alkoivat purra
viiksiään, toiset mutista jotakin hampaittensa välistä, tarttuivatpa
jotkut jo miekkansa kahvaan. Silloin sanoi Kmicic:
— Olemme saapuneet tänne lähteäksemme yhdessä teidän
kanssanne
Mitrunyyn, kuten eilen oli puhe. Keli on hyvä ja sää suloinen.
— Minä lähetin tädin jo edeltäpäin sinne, jotta hän valmistaisi
päivällisen. Jos herrat ovat hyvät ja odottavat vähäisen, niin
pukeudun.
Sen sanottuaan hän poistui, ja Kmicic syöksyi toveriensa luo.
— No mitä, kalliit kuomaseni, eikö hän ole kuin itse ruhtinatar?…
Jasinä, Kokoszko? Sinä puhuit minulle pahasta asemasta, mutta
taisitpa seisoa kuin poikanulikka hänen edessään?… Oletko
koskaan nähnytsellaista?
— Olisit antanut vain minun puhua rauhassa… vaikka kyllä minä
tunnustan, etten ole tottunut puhumaan sellaiselle hovinaiselle.
— Everstivainaja, — selitti Kmicic, — oli usein hänen kanssaan
Kiejdanyssa vojevodaruhtinaan hovissa tai herra Hlebowiczin luona:

38. siellä hän on oppinut ylhäisiä tapoja. Entä eikö ollut kaunis?…
Kylläpäs te olette vieläkin hämmästyneitä!
— Hän mahtaa pitää meitä pässinpäinä! — tiuskaisi Ranicki
harmistuneena. — Mutta suurin pässinpää on Kokosinski!
— Sinä petturi! Itse työnsit minua kylkeen, kun häpesit rupista
naamaasi!
— Hiljaa, pojat, hiljaa! — sanoi Kmicic. — Ihailla saatte, mutta ette
tapella.
— Minä juoksisin vaikka tuleen hänen tähtensä! — huusi Rekuc.
— Lyö,
Jendrus, mutta minä pidän sanani!
Kmicic ei kuitenkaan aikonut lyödä. Hän oli, päinvastoin, perin
tyytyväinen, kierteli viiksiään ja katseli tovereitaan voitonriemulla.
Samassa astui Aleksandra-neiti sisään, päässä näädännahkainen
lakki, jonka alla hänen kasvonsa näyttivät vieläkin kauniimmilta.
Kaikkimenivät kuistille.
— Tähänkö rekeen me istumme? — kysyi neiti osoittaen
hopeanväristäkarhua. — Ikänä en ole kauniimpaa rekeä nähnyt.
— Kaunis se on, kenenkä sitten lie ollut, sitä en tiedä… se on
nimittäin sotasaalis. Me, kuljeskelevat ritarit, joilta sota on kaiken
omaisuuden vienyt, emme omista muuta kuin mitä sota myös antaa.
Olen sodan jumalatarta uskollisesti palvellut, ja hän on uskollisuuteni
palkinnut.
— Jumala suokoon, että saisitte paremman palkinnon, sillä tämä
palkitsee vain yhtä, samalla kuin koko isänmaa vuodattaa kyyneleitä.

39. Kmicic peitti Oleńkan komealla, valkoisella rekipeitteellä, johon oli
ommeltu valkoisia suden kuvia, istuutui sitten viereen ja huusi
ajajalle: »Anna mennä!» Hevoset läksivät juoksemaan.
Kylmä ilma virtasi kasvoja vastaan ja vaikeutti hengitystä. Kuului
lumen nitinää jalasten alla, hevosten korskuntaa, kavioitten kapsetta
ja ajajain huutoja.
Yht'äkkiä herra Andrzej nojasi Oleńkan puoleen ja kysyi:
— Onko hyvä olla?
— On, — vastasi Oleńka nostaen hihansa suojellakseen sillä
kasvojaanvinhalta viimalta.
Reki kiiti vihurina. Päivä oli kirkas ja kylmä. Lumi kimalteli
ikäänkuin joku olisi sirotellut sille kiteitä. Mökkien katoilta nousi
punertava savu patsaina ilmaan. Parvi variksia lensi rääkkyen rekien
editse lehdettömien puitten välitse. Jonkin matkan päässä
Wodoktysta tie painui synkkään, hiljaiseen metsään, joka näytti
nukkuvan lumitaakkansa alla. Puut vilahtivat ohi niin vinhasti, että
tuntui siltä, kuin hevosilla olisi ollut siivet. Sellainen vauhti huimaa ja
huumaa; niin kävi Aleksandra-neidinkin. Hän heittäytyi reen
selkämystää vasten, sulki silmänsä, antautui huimaavan vauhdin
valtoihin jatunsi suloista uupumusta. Hänen mielessään heräsi
ajatus, että tuoorszalainen aatelismies oli ryöstänyt hänet ja kiiti nyt
vihurina pois, eikä hänellä, ryöstetyllä naisella, ollut voimia vastustaa
eikä huutaa… Ja he lentävät yhä nopeammin ja nopeammin…
Oleńka tuntee,kuinka jonkun käsivarret kietoutuvat hänen
ympärillensä… tuntee samassa huulillaan jotakin hehkuvaa,
polttavaa… silmät eivät jaksa avautua, ne ovat unenraskaat… He
lentävät… lentävät… Vihdoinherättää uinuvan neidon kysyvä ääni:

40. — Rakastatko minua? Oleńka avasi? silmänsä:
— Kuin omaa sieluani!
— Ja minä kautta elämän ja kuoleman! Kmicicin
soopelinnahkainen lakki kallistui taas Oleńkan näädännahkaisen
lakin puoleen. Neitonen eitietänyt enää itsekään, mikä häntä
enemmän huumasi, suudelmat vaikotämä huimaava vauhti.
Ja he lensivät yhä kauemmas halki metsien, metsien. Puut jäivät
taakse joukoittain. Lumi lenteli, hevoset korskuivat, ja he olivat
onnellisia.
— Näin tahtoisin ajaa halki maailman! — huudahti Kmicic.
— Mitä olemmekaan tehneet? Syntiä! — kuiskasi Oleńka.
— Eihän tämä mitään syntiä ole! Annapas vielä tehdä syntiä!
— Ei, ei… Olemme jo lähellä Mitrunya.
— Lähellä tai kaukana, yhdentekevä!
Ja Kmicic nousi seisomaan reessä, kohotti käsivartensa taivasta
kohtija alkoi huutaa kuin ilon kyllyydestä:
— Hei… vaan! Hei… vaan!
— Hei! Hei! Hei! Hei! Hop! — vastasivat toverit takana olevista
reistä.
— Miksi noin huudatte? — kysyi Oleńka.
— Ilosta! Ilosta! Huuda sinäkin, neitoseni!

41. — Hei… vaan! — kuului hento naisen ääni.
— Kuningattareni! Minä polvistun jalkojesi juureen!
— Toverit nauraisivat.
Heidät valtasi hurja, huima ilo, yhtä huima kuin vauhtikin. Kmicic
alkoi laulaa:
— Ja pihalta katseli neitonen päin kaukaista peltojen
rantaa. »Kas, äitini, joukkoa ritarien! Oi, mitähän kohtalo
antaa?» »Älä, tyttöni, katso, vaan silmäsi jo käsilläs valkeilla
peitä, sun sydämes särkyisi varmasti, jos sotaan käyt
vastahan heitä.»
— Kuka on opettanut teille noin kauniita lauluja? — kysyi
Aleksandra-neiti.
— Sota, Oleńka. Leirissä olemme tätäkin ikävissämme laulelleet.
Heidän keskustelunsa katkesi, sillä takimmaisista reistä huudettiin
kovasti:
— Seis! Seis! Kuulkaa siellä! Seisottakaa! Herra Andrzej kääntyi
ympäri suuttuneena ja hämmästyneenä ja näki muutaman askelen
päässäratsastajan, joka läheni kovaa vauhtia.
— Kautta Jumalan! Sehän on minun ratsuvääpelini Soroka; jotakin
ontapahtunut! — sanoi herra Andrzej.
Sillävälin oli vääpeli ajanut reen viereen ja pysähdytti hevosensa
niinäkkiä, että se nousi takajaloilleen.
— Herra ratsumestari! — alkoi hän hengästyneenä.

42. — Mitä nyt, Soroka?
— Upita palaa… siellä tapellaan!
— Jeesus Maaria! — huudahti Oleńka.
— Ei mitään hätää, Oleńka… Kutka tappelevat?
— Sotilaat ja kaupunkilaiset. Nämä ovat lähettäneet hakemaan
apua Poniewieźista, mutta minä ajoin ilmoittamaan teidän
armollenne. Olenaivan hengästynyt…
Samassa olivat takimmaisetkin reet siinä. Kokosinski, Ranicki,
Kulwiec-Hippocentaurus, Uhlik, Rekuc ja Zend hyppäsivät lumelle ja
ympäröivät keskustelevat.
— Mikä oli syynä? — kysyi Kmicic.
— Kaupunkilaiset eivät suostuneet antamaan ylläpitoa hevosille
eikä miehille, kun ei ollut määräystä; sotilaat rupesivat ottamaan
väkivallalla. Me piiritimme pormestarin ja torille varustuksien suojaan
asettuneet joukot ja sytytimme kaksi taloa tuleen. Nyt siellä on hirveä
hälinä, ja hätäkelloja soitetaan…
Kmicicin silmät alkoivat säihkyä vihaa.
— Meidän täytyy lähteä auttamaan! — huusi Kokosinski.
— Sotaväkeä kurittavat! — ärjäisi Ranicki, jonka kasvoille nousi
punaisia, valkoisia ja mustia täpliä. — Mikä häpeä!
Zend huusi kuin huuhkain, että hevosetkin pelästyivät, ja Rekuc
vikisinostaen katseensa taivasta kohti:

43. — Iskekää, Jumalan nimessä!
— Hiljaa! — huusi Kmicic, niin että metsä kaikui ja lähinnä seisova
Zend huojahti kuin juopunut. — Ei teitä siellä tarvita! Turhia ovat
murhat! Istuutukaa kahteen rekeen, antakaa minulle yksi, ja
ajakaammeLubicziin. Siellä täytyy teidän odottaa, ehkä lähetän teiltä
apuahakemaan.
— Mitä? — sanoi Ranicki vastustavasti. Mutta herra Andrzej tarttui
hänen niskaansa, ja hänen silmänsä säihkyivät entistä enemmän.
— Ei sanaakaan! — sanoi hän.
Kaikki vaikenivat. Näkyi, että he pelkäsivät häntä, vaikka
tavallisestielivätkin niin veljellisesti keskenään.
— Oleńka palatkoon Wodoktyyn, — sanoi Kmicic, — tai ajakoon
tätiKulwiecin luo Mitrunyyn. Huvimatkamme päättyi ikävästi. Tiesin,
etteivät ne siellä pysyisi rauhassa… Mutta kyllä ne kohta
rauhoittuvat, kun muutamat menettävät päänsä. Hyvää voimista ja
rauhaa,kohta käyn talossa taas…
Sen sanottuaan hän suuteli Oleńkan kättä, peitti neitosen
sudennahkoihin, istuutui toiseen rekeen ja huusi ajajalle:
— Upitaan!

44. NELJÄS LUKU.
Kului muutamia päiviä, mutta Kmicic ei palannutkaan. Sensijaan
saapui Wodoktyyn kolme laudalaista aatelismiestä. Yksi näistä oli
Pakosz Gasztowt Pacunelesta, sama, joka piti herra Wolodyjowskia
luonaan vieraana ja joka oli kuuluisa rikkauksistaan ja kuudesta
tyttärestään, joista kolme oli naimisissa kolmella Butrymilla, kukin
sadan hopeataalerin myötäjäisineen, paitsi muuta irtainta. Toinen oli
Kassyan Butrym, Laudan vanhin mies, joka hyvin muisti kuningas
Batoryn, ja kolmas Pakoszin vävy, Jozwa Butrym. Vaikka Jozwa oli
parhaassa miehuuden iässä, ei hän ollut noudattanut yleistä
kutsuntaa, sillä hän oli menettänyt kasakkasodissa toisen jalkansa,
minkätähden hän olikin saanut liikanimen Jalaton. Muuten hän oli
peloittava mies,vahva kuin karhu, älykäs, mutta karkea, tulinen ja
ankarasti ihmisiä arvosteleva. Häntä kunnioitettiin, sillä hän ei voinut
suoda mitään anteeksi itselleen enemmän kuin muillekaan. Erittäin
vaarallinen hänoli juovuspäissään, mikä muuten sattui hänelle
harvoin.
Nämä kolme olivat saapuneet neiti Billewiczin luo. Tämä otti
vieraansa ystävällisesti vastaan, vaikka hän heti arvasikin, että
vieraat olivattulleet hankkimaan tietoja herra Kmicicistä.