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Health Assessment in Nursing 6th

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1. A nurse on a postsurgical unit is admitting a client following the client's

cholecystectomy (gall bladder removal). What is the overall purpose of assessment for
this client?
A) Collecting accurate data
B) Assisting the primary care provider
C) Validating previous data
D) Making clinical judgments

2. A client has presented to the emergency department (ED) with complaints of abdominal
pain. Which member of the care team would most likely be responsible for collecting
the subjective data on the client during the initial comprehensive assessment?
A) Gastroenterologist
B) ED nurse
C) Admissions clerk
D) Diagnostic technician

3. The nurse has completed an initial assessment of a newly admitted client and is applying
the nursing process to plan the client's care. What principle should the nurse apply when
using the nursing process?
A) Each step is independent of the others.
B) It is ongoing and continuous.
C) It is used primarily in acute care settings.
D) It involves independent nursing actions.

4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and
perform a comprehensive health assessment. Which of the following actions should the
nurse perform first?
A) Review the client's medical record.
B) Obtain basic biographic data.
C) Consult clinical resources explaining the client's diagnosis.
D) Validate information with the client.

5. Which of the following client situations would the nurse interpret as requiring an
emergency assessment?
A) A pediatric client with severe sunburn
B) A client needing an employment physical
C) A client who overdosed on acetaminophen
Page 1
D) A distraught client who wants a pregnancy test

Page 2
6. In response to a client's query, the nurse is explaining the differences between the
physician's medical exam and the comprehensive health assessment performed by the
nurse. The nurse should describe the fact that the nursing assessment focuses on which
aspect of the client's situation?
A) Current physiologic status
B) Effect of health on functional status
C) Past medical history
D) Motivation for adherence to treatment

7. After teaching a group of students about the phases of the nursing process, the instructor
determines that the teaching was successful when the students identify which phase as
being foundational to all other phases?
A) Assessment
B) Planning
C) Implementation
D) Evaluation

8. The nurse has completed the comprehensive health assessment of a client who has been
admitted for the treatment of community-acquired pneumonia. Following the
completion of this assessment, the nurse periodically performs a partial assessment
primarily for which reason?
A) Reassess previously detected problems
B) Provide information for the client's record
C) Address areas previously omitted
D) Determine the need for crisis intervention

9. The nurse is working in an ambulatory care clinic that is located in a busy, inner-city
neighborhood. Which client would the nurse determine to be in most need of an
emergency assessment?
A) A 14-year-old girl who is crying because she thinks she is pregnant
B) A 45-year-old man with chest pain and diaphoresis for 1 hour
C) A 3-year-old child with fever, rash, and sore throat
D) A 20-year-old man with a 3-inch shallow laceration on his leg

Page 3
10. A nurse has completed gathering some basic data about a client who has multiple health
problems that stem from heavy alcohol use. The nurse has then reflected on her personal
feelings about the client and his circumstances. The nurse does this primarily to
accomplish which of the following?
A) Determine if pertinent data has been omitted
B) Identify the need for referral
C) Avoid biases and judgments
D) Construct a plan of care

11. The nurse is collecting data from a client who has recently been diagnosed with type 1
diabetes and who will begin an educational program. The nurse is collecting subjective
and objective data. Which of the following would the nurse categorize as objective data?
A) Family history
B) Occupation
C) Appearance
D) History of present health concern

12. An older adult client has been admitted to the hospital with failure to thrive resulting
from complications of diabetes. Which of the following would the nurse implement in
response to a collaborative problem?
A) Encourage the client to increase oral fluid intake.
B) Provide the client with a bedtime protein snack.
C) Assist the client with personal hygiene.
D) Measure the client's blood glucose four times daily.

13. The nurse at a busy primary care clinic is analyzing the data obtained from the
following clients. For which clients would the nurse most likely expect to facilitate a
referral?
A) An 80-year-old client who lives with her daughter
B) A 50-year-old client newly diagnosed with diabetes
C) An adult presenting for an influenza vaccination
D) A teenager seeking information about contraception

14. An instructor is reviewing the evolution of the nurse's role in health assessment. The
instructor determines that the teaching was successful when the students identify which
of the following as the major method used by nurses early in the history of the
profession?
A) Natural senses
B) Biomedical knowledge
C) Simple technology
D) Critical pathways

Page 4
15. When describing the expansion of the depth and scope of nursing assessment over the
past several decades, which of the following would the nurse identify as being the
primary force?
A) Documentation
B) Informatics
C) Diversification
D) Technology

16. A group of nurses are reviewing information about the potential opportunities for nurses
who have advanced assessment skills. When discussing phenomena that have
contributed to these increased opportunities, what should the nurses identify?
A) Expansion of health care networks
B) Decrease in client participation in care
C) The shrinking cost of medical care
D) Public mistrust of physicians

17. A nurse has documented the findings of a comprehensive assessment of a new client.
What is the primary rationale that the nurse should identify for accurate and thorough
documentation?
A) Guaranteeing a continual assessment process
B) Identifying abnormal data
C) Assuring valid conclusions from analyzed data
D) Allowing for drawing inferences and identifying problems

18. A nurse has received a report on a client who will soon be admitted to the medical unit
from the emergency department. When preparing for the assessment phase of the
nursing process, which of the following should the nurse do first?
A) Collect objective data.
B) Validate important data.
C) Collect subjective data.
D) Document the data.

19. A community health nurse is assessing an older adult client in the client's home. When
the nurse is gathering subjective data, which of the following would the nurse identify?
A) The client's feelings of happiness
B) The client's posture
C) The client's affect
D) The client's behavior

Page 5
20. A nurse on the hospital's subacute medical unit is planning to perform a client's focused
assessment. Which of the following statements should inform the nurse's practice?
A) The focused assessment should be done before the physical exam.
B) The focused assessment replaces the comprehensive database.
C) The focused assessment addresses a particular client problem.
D) The focused assessment is done after gathering subjective data.

21. The nurse is reviewing a client's health history and the results of the most recent
physical examination. Which of the following data would the nurse identify as being
subjective? Select all that apply.
A) ìI feel so tired sometimes.î
B) Weight: 145 lbs
C) Lungs clear to auscultation
D) Client complains of a headache
E) ìMy father died of a heart attack.î
F) Pupils equal, round, and reactive to light

22. The nurse has been applying the nursing process in the care of an adult client who is
being treated for acute pancreatitis. Place the nurse's actions in their proper sequence
from first to last.
A) Identifying outcomes
B) Determining client's nursing problem
C) Collecting information about the client
D) Determining outcome achievement
E) Carrying out interventions

23. A nurse is completing an assessment that will involve gathering subjective and objective
data. Which of the following assessment techniques will best allow the nurse to collect
objective data?
A) Inspection
B) Therapeutic communication
C) Interviewing
D) Active listening

24. The nurse is performing a health assessment on a community-dwelling client who is

recovering from hip replacement surgery. Which of the following actions should the
nurse prioritize during assessment?
A) Focus the assessment on the client as a member of her age group.
B) Interpret the information about the client in context.
C) Corroborate the client's statements with trusted sources.
D) Gather information from a variety of sources.

Page 6
25. A client comes to the health care provider's office for a visit. The client has been seen in
this office on occasion for the past 5 years and arrives today complaining of a fever and
sore throat. Which type of assessment would the nurse most likely perform?
A) Comprehensive assessment
B) Ongoing assessment
C) Focused assessment
D) Emergency assessment

26. A nurse has assessed a client who was admitted to the medical unit to treat acute
complications of type 1 diabetes. During the assessment, the client admitted that his
blood sugar monitoring when he is at home is ìa bit sporadic.î How should the nurse
best respond to this assessment finding?
A) Identify a nursing diagnosis of Ineffective Health Maintenance.
B) Identify a collaborative problem that should involve the occupational therapist.
C) Make a referral to the unit's social work department.
D) Reassess the client's blood glucose level.

27. The nurse is utilizing the Health Belief Model in the care of a client whose type 1
diabetes is inadequately controlled. When implementing this model, the nurse should
begin by assessing which of the following?
A) The client's motivation for change
B) The client's medical comorbidities
C) The client's learning style
D) The client's prognosis for recovery

28. A nurse will complete an initial comprehensive assessment of a 60-year-old client who
is new to the clinic. What goal should the nurse identify for this type of assessment?
A) Identify the most appropriate forms of medical intervention for the client.
B) Determine the most likely prognosis for the client's health problem.
C) Identify the status of the client's airway, breathing, and circulation.
D) Establish a baseline for the comparison of future health changes.

29. A nurse who provides care in a hospital setting is creating a plan of nursing care for a
client who has a diagnosis of chronic renal failure. The nurse's plan specifies frequent
ongoing assessments. The frequency of these nursing assessments should be primarily
determined by what variable?
A) The client's age
B) The unit's protocols
C) The client's acuity
D) The nurse's potential for liability

Page 7
30. A client who is new to the facility has a recent history of chronic pain that is attributed
to fibromyalgia. The nurse has reviewed the available health records and suspects that
pain management will be a major focus of nursing care. How can the nurse best validate
this assumption?
A) Review the client's medication administration record for analgesic use.
B) Ask the client about the most recent experiences of pain.
C) Meet with the client's spouse and daughter to discuss the client's pain.
D) Collaborate with the physician who is treating the client.

Page 8
Answer Key
1. D
2. B
3. B
4. A
5. C
6. B
7. A
8. A
9. B
10. C
11. C
12. D
13. B
14. A
15. D
16. A
17. C
18. C
19. A
20. C
21. A, D, E
22. C, B, A, E, D
23. A
24. B
25. C
26. A
27. A
28. D
29. C
30. B

Page 9
Another Random Scribd Document
with Unrelated Content
 Chapter VIII

M iss Cornelia and Miss Joanna sat at the breakfast-table and

looked aghast at Elizabeth, who had just informed them of her
engagement. The old Dutch clock on the mantel-piece ticked loudly,
the sunlight fell in shining bars upon the snowy table-cloth, the old
Dutch china, the glistening silver. Miss Cornelia was reminded
forcibly, painfully, of a morning in that same room many years ago,
when Peter had announced his marriage. Now the shock was not so
great, was not unexpected, perhaps; but it brought with it, if less
horror, an even greater disappointment.
"Well," Elizabeth said, after a moment, when her important
announcement had produced no response, and she looked proudly,
yet half wistfully, from one to the other. "Well," she repeated, "have
you nothing to say? Can't you—congratulate me?" Her voice faltered
over the last words.
"My dear," Miss Cornelia tried bravely to respond to the appeal in the
girl's tone. "Of course, we—we wish you every happiness," she
stammered out. She stopped, for tears choked her voice. She looked
despairingly at her sister. Was this the moment that they had so
often talked of together, planning with delicious thrills of pleasure all
they would say and do? "This china must be Elizabeth's when—when
she marries, you know." "We must lay by a little for—for Elizabeth's
trousseau." This in demure whispers to each other, for they would
not for the world have suggested such a possibility to the girl herself.
Nice girls, of course, must not think of getting married till the time
came, but—with Elizabeth's beauty, that time could not be long
delayed, not even in the Neighborhood. The fairy prince would
appear some day; though he had never come to them, they believed
devoutly that he would come to Elizabeth. And now—and now—the
fairy prince had come, or Elizabeth thought so; but they were only
conscious of an overwhelming sense of doubt.
"You know so little about him, my dear," Miss Cornelia could not help
at last protesting.
Elizabeth opened her eyes wide in genuine surprise. "So little of
him," she repeated. "Why, I—I know everything, Aunt Cornelia." And
she smiled to herself in silent amusement. Had she not seen him,
every day and twice a day, for a matter of four weeks. How long did
they think, these older women, that it took to know a man? "I know
that he loves me," she said, after a moment, descending to further
particulars "and I love him, and that's enough."
"But you can't live on love," urged Miss Joanna, practically. "You
must have some money, you know, and I shouldn't think he, poor
young man, had anything—at least, judging by his clothes. Those
artists never have, they say. And meat, and everything indeed, never
was so dear as it is now."
"I didn't know you were so worldly, Aunt Joanna," said Elizabeth,
loftily. "Do you want me to marry for money?" Miss Joanna was
crushed. But as she reflected in her own justification, one had to
have something to eat, let lovers say what they would.
"My dear," said Miss Cornelia, coming to the rescue with the little air
of dignity that she could sometimes assume "we certainly wouldn't
want you—not for the world—to marry for money. But one has to be
—to be prudent. We have brought you up in a way—perhaps it was
unwise—poor Mother would have thought so. But at any rate you
know nothing about economy, and—and you have only a little
money, my dear, and he, I suppose, has nothing."
"He—he expects to make a great deal of money soon," faltered
Elizabeth, coming down a little from her heights of romance. All this
prudence was like a dash of cold water in the face. She felt
disconcerted, indignant, and yet conscious, through it all of some
reason in her aunts' objections. Yes, it was true—she had not been
brought up to economy, she was fond of luxury and pretty things. In
all her wishes for change, she had never thought that it would be
amusing to miss any of these.
Miss Cornelia saw that she had produced some effect. "I think," she
went on, still speaking with unusual decision, "that the most
important thing is to find out something about him. You can't marry
a man whom we know nothing about, except that—that he was born
at The Mills. We must investigate his character." Miss Cornelia felt, as
she brought out this last sentence, that it sounded eminently
practical, and it received from Miss Joanna, indeed, its full meed of
respectful admiration. Elizabeth only smiled superior.
"You can investigate as much as you like, Aunt Cornelia," she said. "I
know all about him." And so the matter rested.
But how could two elderly and innocent spinsters, who had never in
their lives stirred two hundred miles from home, investigate the
character of a young man who had lived in Chicago and Paris and
Vienna and all the four quarters of the world apparently? They had
no idea how to set about it. In this perplexity Miss Cornelia again
rose to the occasion, and suggested that the Rector might be a fit
substitute for that invaluable possession "a man in the family," who
is always supposed to accomplish so much. And the Rector, when
consulted, proved unexpectedly resourceful. He had made Paul's
acquaintance, and learned the name of the church in Chicago where
he had sung for so many years. He had discovered, too, that the
Rector of this church was an old college friend of his, and he wrote
to him at once, requesting full and confidential information as to the
young man's character, antecedents, and prospects.
The answer seemed to the poor ladies a long time in coming; as a
matter of fact, it arrived very promptly. The Rector of St. Anne's at
Chicago regretted to inform his old friend and colleague the Rector
of St. Mary's, at Bassett Mills, that he had no good account to give
of Paul Halleck, who had not long ago been dismissed from the choir
of his church, and had left behind him in Chicago many debts and a
bad reputation. The young man was believed to have, as the Rector
added, genuine musical talent; but like many artists and musicians,
he was morally irresponsible, dissipated and reckless.
The Rector of St. Mary's repeated the verdict, as gently as he could,
to the older ladies at the Homestead. They bore it better than he
expected. There were compensations indeed in the very extent of its
severity. Had Halleck been less evidently and irredeemably a black
sheep, there might have been some doubts as to their own duty;
but, as it was, they felt that they must break off the dreadful match
at once, and at any cost.
Yet the heart of each sister misgave her as they sat in a solemn
conclave, and summoned Elizabeth before it. She came, rosy, bright-
eyed, fresh from talks with her lover and happy dreams of a brilliant
future, which they were to share together. She stood listening in
apparent indifference, while Miss Cornelia faltered out the painful
result of their inquiries. And when the worst was told, she had
turned perhaps a trifle pale, but otherwise she seemed unmoved.
"I don't know why you tell me all this, auntie," she said, slowly. "I—I
am sorry to hear it, but it can make no difference."
"No difference!" Miss Cornelia repeated, stupefied. "No difference,
Elizabeth?"
"No, it can't change my love for him," she said, defiantly. "He told
me that he has enemies at Chicago, and that you would probably
unearth a lot of old scandals; and I promised that it should make no
difference. Perhaps some of them are true; I don't care. Auntie, I
can't—I can't give him up," she went on with a sudden change of
tone and clasping her hands appealingly. "I tried to once before, and
—I couldn't. If he were to go away now and leave me, I—I should
die. I couldn't bear to go on living without him." The girl's face was
flushed, her voice tremulous with feeling; it was evident that she
fully meant—or thought that she meant—what she said. Her aunts
looked at her in helpless perplexity.
"My darling," Miss Cornelia faltered at last, "think how much better it
is to give him up now than to—to marry him and be unhappy. You
don't know—men are very bad;—one reads such things in the
newspapers. If he were to ill-treat you, desert you."
"Ah, but he won't," said Elizabeth, smiling incredulously. "You
needn't worry, Aunt Cornelia; we shall be very happy. But even if we
were not," she concluded, with a sudden burst of defiance. "If I
thought that he would beat me, treat me like a dog—I don't care; I
should marry him to-morrow."
And she thrust out her full under lip, and stood facing them, with a
look of obstinacy on her fair, girlish face, that for the moment bore a
strong resemblance to her father.
To Miss Cornelia's mind there rose again, with startling vividness, the
events of twenty years before. The recollection seemed to endow
her with an unwonted and unnatural strength. She went over to
where Elizabeth stood and took both the girl's hot hands in hers.
"Elizabeth," she said, desperately, "you don't know what you're
saying. You will be miserable if you marry that man. You don't know
what it is to live with a person who is beneath you, who—who drags
you down. We know, my darling, we have seen it. Be warned by us,
and give him up."
Miss Cornelia had never in all her gentle life spoken with so much
vehemence. Elizabeth, in her astonishment, stood for a moment
absolutely passive. She stole a glance at Miss Joanna; she was
weeping quietly. Elizabeth's own face worked, her lip quivered. "I
know whom you mean," she broke out, suddenly, in a quick hard
voice. "You're thinking of my mother." And then, in the dismayed
pause that followed, she dragged her hands away from Miss
Cornelia's grasp and fled from the room.
The two older women looked at one another in silence.
"I didn't know," Miss Joanna said at last in a low, awe-struck tone
"that the child knew anything about—about poor Malvina."
 Chapter IX

"A nd so you let all this nonsense influence you?" Halleck asked
this bitterly, staring up with moody eyes into Elizabeth's face.
They were sitting under a wide-spreading tree, in a field not far from
the Homestead. It was late afternoon and the shadows were long
and peaceful. A ray from the sinking sun shot through the foliage
overhead lighting up the red tints of Elizabeth's hair. Halleck's artistic
eye rested upon them fascinated. He had never, as he told himself,
been so much in love before.
"You give me up because of a little opposition?" he went on bitterly,
roused to increased irritation by the thought of losing her.
"Why, what can I do?" The girl's voice was weary, and she threw out
her hands with a helpless gesture. "They will give in to me, I
suppose, if I insist; but it makes them too unhappy. I believe it
would kill them. If they were unkind, I shouldn't care; but they only
cry, and are so wretched, and I can't stand it. It makes me feel so
ungrateful."
"And yet," said Halleck, anxiously, "you think they will give in in the
end?"
"Oh, yes, they'll give in," said Elizabeth, wearily. "They'll give in, if I
insist; and that's the very reason why I—what makes it so hard, you
see."
"No, I don't see," said Paul, bluntly. "If you think they will give in,
why are you so unhappy? But I understand how it is" he went on,
harshly, "you don't love me. I'm too far beneath you—a Bohemian
and an outcast. You are glad of an excuse to throw me over."
"Paul!" The indignant color flushed into Elizabeth's face. "How can
you say such things," she asked reproachfully. "You know they are
not true. I told my aunts that I would never give you up; I told them
that—that I would marry you to-morrow, if I could."
"You told them that?" Paul exclaimed exultantly. He put his arm
around her and drew her towards him. "Then keep your word,
darling," he said. "Marry me to-morrow."
Elizabeth shrank away, startled. "Marry you," she repeated. "To-
morrow, how could I?"
"Why not," said Paul, quietly. "Come up to Cranston and we will be
married. Then let them say what they please."
Elizabeth was very pale. "I couldn't do that," she said in a low voice.
"I don't want to be married so soon; and besides—it would kill my
aunts."
He laughed. "Nonsense! People soon resign themselves to what they
can't help. And then they needn't know—yet awhile. Listen, darling,
this is my plan. You know that I want to go abroad—well, I have had
a letter offering me a position in an opera company in Munich. If I
accept it I start this week."
He stopped as Elizabeth gave a little cry and stared up at him with
reproachful eyes. "This week," she said. "You go away this week?"
"Why, I can't stay here forever, you know," Paul said. "I've idled
away my time unconscionably already—but that is your fault,
Elizabeth. Now it is time I went to work. And that is why I say—
marry me before I go. Then, while I am away, nothing can separate
us."
Elizabeth, pale and thoughtful, seemed to ponder the suggestion.
"Marry you," she repeated, slowly. "Marry you—now at once?"
"Yes, to-morrow," said Paul, boldly.
"And—and keep it secret?" she went on, with a troubled look.
"Yes, for a little while," said Paul, "for a few months, till I come back.
I shall have made my name and my fortune, darling, I hope, by that
time, and your aunts will be quite reconciled to me."
"Then wouldn't it be better," said Elizabeth, with much reason, "to
wait till then?"
"Are you willing to wait—in uncertainty all this time?" he asked,
reproachfully. "Ah, Elizabeth, it is evident that you don't love me as I
love you. Such an absence would be unbearable to me, if I felt that
some lover was likely to come along at any time and take you from
me."
Elizabeth could not help reflecting that the danger of such a
catastrophe did not seem imminent, in the present condition of the
Neighborhood; but she did not put the thought into words. She only
said, with some dignity: "I don't think that I am the sort of girl to
change so easily."
"Ah, you can't tell," said Paul. "Women are fickle beings. I don't trust
you, Elizabeth. I have a feeling that, if you don't marry me now, you
never will. And why should you hesitate?" he went on eagerly. "It
isn't so much that I ask. I don't even say—come abroad with me
now; only give me the certainty that when I come back, I shall be
able to claim you."
"You would have that certainty now," she still insisted. "I promise
that I will marry you when you come back."
"Then why not marry me now," he asked, triumphantly.
Elizabeth could give no good reason to the contrary. The idea was
vaguely alarming, yet it held for her a certain fascination. She sat
listening in troubled uncertainty, while Paul discoursed with
enthusiasm over the many advantages of his plan. He was
exceedingly anxious, as he had said, to make sure of this beautiful
girl, who was, he vaguely felt, a little above him—of a grade superior
to that of the other girls whom he had known and made love to, for
the space of a fortnight perhaps. He had been true to Elizabeth,
now, for more than double that time. He really believed that he
should be true to her always. There were other things that attracted
him besides her beauty. The thought that Elizabeth was Miss Van
Vorst of the Homestead was not unpleasant to him; the old house,
the family silver, the family traditions, appealed to his artistic sense
of fitness. And then though he was no fortune-hunter, and certainly
would have made love to no girl whom he did not for the moment at
least sincerely admire, he admitted to himself, frankly, that it was by
no means inconvenient that Elizabeth should have a little money of
her own and the prospect of more in the future. The Van Vorst
property, while it was insignificant enough when measured by the
standard of the Van Antwerps and other rich people in the
Neighborhood, seemed by no means contemptible to Paul, who
measured it by the standard of poverty-stricken Bohemia.
Elizabeth's feelings were more complex, less frankly selfish, much
more anxious and uncertain. The money question did not enter into
them to any great extent, though she had an instinctive dread of
poverty, and she was convinced that, if once married to Paul, she
would not be able to have the pretty gowns, and other luxurious
trifles, which had hitherto seemed a necessity of life. But she was
young and romantic, and this thought did not weigh with her very
much. What most distressed her, and made her feel in some way
vaguely in the wrong, was the trouble this, her first love affair,
seemed to bring to others; to her aunts, to Amanda. She loved her
aunts, and hated to run counter to their wishes; she did not love
Amanda, and yet the thought of having injured her, though
unconsciously, brought with it an uncomfortable sense of guilt.
She had not seen her since that terrible interview, which she still
could not recall without a feeling of humiliation; but she had seen
her aunt, who told her that Amanda was ill with some low fever—
typhoid malaria, probably; there was always a good deal of that at
The Mills. It was not considered wise that Elizabeth should see her;
and besides, Amanda was delirious, and did not recognize any one.
Elizabeth was more relieved than sorry to hear it. No doubt, she told
herself, Amanda was already out of her head when she uttered that
extraordinary outburst, and it was foolish to attach any importance
to what she said in her feverish excitement. Still, Elizabeth did not
like to think of it, much less of the promise she herself had given,
voluntarily, in such forcible words. She had been so absolutely
sincere in making it; she had broken it so completely within the hour.
The whole affair was unpleasant, and weighed upon her more than
those more serious charges against Paul, which had fallen vaguely
upon her ear, not seeming to make any deep impression. His
conduct to Amanda was at its worst a mere trifle in comparison.
Still she could not give him up. That broken promise to Amanda only
proved this the more strongly. She could not face the prospect of life
without him. And yet she could not face without terrible misgivings
the prospect of further tears and remonstrances from her aunts. The
two claims struggled for the mastery; on the one hand, the claims of
the women who had brought her up, whose every thought for
twenty years had centred in her; on the other, the claims of the man
who had loved her in his light way some five weeks. Under these
circumstances, it was inevitable that the claims of the man should
predominate. And yet Elizabeth longed to satisfy them both.
Paul's plan seemed to suggest a compromise. And Elizabeth had not
yet learned that compromise is never satisfactory to either side.
"Listen," she said, looking at him intently, with eyes that seemed to
hold, even in the moment of yielding, a certain defiance of his
power, "If I do as you wish, if I—I marry you to-morrow, I am free
to—to come home at once, to go on with my life as if nothing were
changed—not to tell my aunts, not to tell any one, till you come
back? Do you promise this, on your word of honor?"
For a moment Paul hesitated. He had hardly expected her to yield so
easily; perhaps if he pressed the matter she might be persuaded
even to go abroad with him at once. But there were financial
reasons which made that inexpedient just then. On the whole, Paul
decided not to test his power too far.
"Upon my word of honor," he said, looking her steadily in the face "I
promise that you shall be free as air, to go on with your life as you
please, till I come back to claim you."
And so the thing was settled. Paul was to go to Cranston early the
next morning to make all necessary arrangements; Elizabeth was to
follow him a little later. They were to be married at once. Then Paul
was to take an afternoon train for New York, Elizabeth was to return
home, the whole affair should remain a secret.
Then Paul, radiantly triumphant, clasped Elizabeth in his arms, and
pressed his lips to hers.
"To-morrow," he whispered, "to-morrow, my darling, at this time—
though the world won't know it—still you will be my wife."
A strange feeling thrilled Elizabeth. She could not have told if it were
pleasure, or some involuntary presentiment. But aloud she repeated
mechanically: "Yes, I shall be your wife."
"You won't fail me, dearest," he said, scanning her face eagerly. "You
won't break your word? You have promised—you won't fail me?"
"No," Elizabeth answered, "I have promised—I won't fail you."
And yet the thought crossed her mind irrelevantly, that she had
broken a promise once already.
She left him and went home through the stillness and the fast
gathering shadows of the evening. The days were already growing
shorter. She noted the fact mechanically; noted too that the deep
glowing crimson of the sunset foretold a hot day for the morrow.
She entered the house and looked in at the dining-room; the table
was set out for tea with all the wonted care. Her aunts sat each at
one end; they were neither of them eating and both had red eyes.
In the centre of the table stood Elizabeth's favorite cake—the kind
with the raisins in it, which she used to beg for as a child, and which
was reserved either as a reward for virtue, or for consolation in
some childish trouble. Now in this trouble that was so far from
childish, poor Miss Joanna had bethought herself of the old
attention, and brought out the favorite cake as the only means of
comfort within her power. Elizabeth could not see it without a lump
in her throat.
She smoothed her ruffled hair before the glass and came in quietly
to her usual place at the table. They looked up nervously at her
entrance, but neither spoke; they did not reproach her with being
late or ask where she had been. Miss Joanna pressed upon her the
various dainties, reminding her that she had eaten no dinner;
otherwise the meal was a silent one. It was not till near the end of it
that Elizabeth spoke in a strained harsh voice unlike her own.
"Paul is going away." That was what she said. "He—has an
engagement to go abroad. He goes to New York to-morrow. I—I
hope you are satisfied."
And then she stopped, for the look of tremulous relief on both their
faces was almost more than she could bear. The raisins in her
favorite cake seemed suddenly to choke her. She began to doubt,
after all, whether she would go to Cranston the next day.
 Chapter X

T was Elizabeth's last thought that night; it was her first in the
his
morning. She dressed herself carefully, putting on white,
according to the custom which had aroused Aunt Rebecca's criticism;
and all the while she asked of the reflection that stared back at her
with perplexed eyes out of the mirror: "Shall I go, or shall I not?"
She put the question to a rose when she got down-stairs, repeating
as she ruthlessly destroyed each petal. "Yes, no, yes, no?" But the
flower answered with a "no," and she threw away the last petal in
disgust.
"I think I shall drive over to The Mills this morning," she announced
quietly at the breakfast-table. "There is some ribbon I want to
match." Her aunts looked up startled. They wondered
simultaneously at what hour Halleck was to leave for New York. Yet
what if after all the child wished for one last meeting?
"You don't think it's—it's too hot to go over there to-day, my dear?"
Miss Cornelia ventured at last uncertainly.
"No, I don't mind the heat," Elizabeth answered indifferently, as she
sat playing with her knife and fork. She was very pale and had no
appetite. This seemed to them only natural. They hoped that when
the young man were once out of the way, their darling would be
herself again.
"We must take her to the sea-shore for a little while," Miss Cornelia
observed when Elizabeth had left the room. "She needs change of
air." Miss Joanna cheerfully assented. The idea and the sacrifice
which it involved (since to go away from home, even for a few
weeks, seemed a terrible undertaking) consoled them both greatly.
And meanwhile Elizabeth went her own way. It was not till she was
seated in the carriage about to start on her drive, that she observed
as if by an afterthought: "Oh, by the way, if I can't match the ribbon
at The Mills, I may go to Cranston for it by the trolley, so don't be
worried if I don't come back till late, and don't wait dinner." Her
aunts looked at one another questioningly; but she drove off at
once, before they could offer any objections.
And so Elizabeth drove towards Bassett Mills. The day was dry and
hot, as were most days that summer. The sun beat down out of a
brazen sky, the roads were white with dust, the grass in the fields
was sere and brown. The locusts all along the way kept up a loud,
exultant song, the burden of which was heat.
To Elizabeth, as she drove on, there began to be something ominous
in it all; in the heat and the dust and the dazzling sunshine and the
locusts with their eternal noise. They seemed all part, and she with
them of some horrible nightmare; she was under some spell which
benumbed her, deprived her of the capacity for thought, of all but
the power to keep doggedly on the way to Bassett Mills. What she
should do when she got there she did not know; her brain was
torpid, there was a strange ringing in her ears. It was the sun, no
doubt, that was affecting her head; it would be wise to turn back, or
she might be ill. But still she kept on.
It was not far from noon when she reached Bassett Mills. There was
little life about the place this hot morning; the mill-stream even
seemed to dash less tumultuously, and showed signs of running dry.
A group of men stood outside the drug-store, which was a great
meeting-place, and discussed the drought. It was decided that if it
continued the crops would be ruined; but hopes were founded on
the fact that prayers for rain were to be offered in all the churches
on Sunday.
"But there's not much use praying for rain," said one skeptic, "when
the wind's due west."
Elizabeth heard the words as she drove up, and, alighting tied the
white pony to a post and bribed a small boy to "keep an eye" on
him. Then she joined the group in front of the shop, who were some
waiting for the trolley, others merely passing the time of day. She did
not go into the dry-goods shop to try to match her ribbon; she knew
that such ribbon as she wanted was not to be had at Bassett Mills.
She stood idly listening to the men's conversation, and wondering if
it were indeed true, as the skeptic had declared, that it was useless
to pray for an event already determined by natural causes. She had
been brought up to believe implicitly in the efficacy of prayer, and
had added to her usual formula that morning a petition of unwonted
fervor that she might be enabled in this perplexing situation to
decide for the best. But perhaps there was no use in praying;
perhaps one was not a free agent. Fate, she thought, had evidently
determined that she should go to Cranston that morning to be
married, since it was a thing that might so easily have been
prevented—by an objection from her aunts, an offer of company on
the expedition, even by the white pony going lame; she would have
yielded, or so she thought, to the merest trifle, glad to have the
decision taken out of her hands. But everything had been made
easy; it evidently was to be. And an implicit believer in heredity
might have observed that the matter had been decided for her, by
events and influences which had moulded her character even before
she was born. It was in just such clandestine fashion as this that her
parents had once gone up to Cranston to be married; and it might
be that some mysterious hereditary instinct, some force over which
she had no control, was now constraining their daughter, under the
same circumstances, to act in the same way.
Elizabeth, fortunately or otherwise, did not think of this. She only
knew that she was standing outside the drug-store with the other
loiterers, straining her eyes along the dusty white road for a sight of
the trolley; and that, even while she doubted the wisdom of waiting,
some fascination held her rooted to the spot. When the trolley came
she took her seat at once. After all a trip to Cranston meant nothing;
she might simply buy her ribbon and come back.
The trolley started off fast and jerkily, creating a teasing wind, that
seemed to blow from some fiery furnace. Elizabeth clutched her hat
with one hand, while with the other she tried to shield her eyes from
the flying dust and glare. Soon they were past the cemetery and the
straggling outskirts of Bassett Mills, out into the open country, with
rolling meadow and upland on either side, all withered, scorching
under the sun's fierce rays. An occasional wagon met them, wrapped
in a cloud of dust; the trolley was hailed now and then from some
solitary farm-house, and came to a sudden stop. The ride seemed
endless, but that they were approaching Cranston was at last made
evident by unmistakable signs; by the advertisements staring at
them from trunks of trees and the expanse of stone walls; by the
asphalt pavement that succeeded the rough country road, the
increasing quantity of bicycles, carriages and dust; and finally by the
neat rows of Queen Anne villas, with their gabled fronts and terraced
gardens sloping to the road. Then the car, with a last triumphant
jerk, turned a corner and landed its passengers squarely in the High
Street of Cranston.
Elizabeth alighted rather limply, and stood looking about her in a
dazed sort of way. A country woman laden with parcels addressed
her timidly. "Excuse me miss," she said, "but would you tell me the
best place to go for stockings?"
Elizabeth started and stared at her, as if the simple question had
been put in Hebrew. Then in a moment she recovered herself and
directed the woman very civilly. She watched her bustle off upon her
round of errands, then turned and slowly walked into the
confectioner's shop. It was there that she had promised to meet
Paul.
There was no one, as it happened, in the front part of the shop,
where candy and cake were sold; no one in the little restaurant at
the back. Elizabeth sat down at one of the small marble-topped
tables; her head was aching, her eyes blood-shot, she was conscious
of nothing but a feeling of pleasure in the coolness and darkness, of
relief from the outside glare. Mechanically, she glanced at the small
mirror, that hung at an unbecoming angle opposite on the wall, and
felt a slight shock at the sight of herself—pale, worn, with blood-shot
eyes, her white gown dusty and bedraggled. No, she did not look
well—she had never looked worse in her life. Her lips curled in an
unmirthful smile, as she thought irrelevantly of Aunt Rebecca, and of
how she might have held forth on the folly of wearing white for such
a dusty ride. And thereupon with a sudden pang, came the thought
of Amanda—Amanda, tossing no doubt just then in the delirium of
fever. The unpleasant idea struck Elizabeth of a resemblance
between her own white face in the mirror, and her cousin's face as
she had last seen it, with those staring, red-rimmed eyes. Certainly,
there was a latent family likeness; but it took unbecoming conditions
such as these to bring it out. She wondered languidly if any one else
had ever noticed it.
Poor Amanda! Was she still, in her delirium, fretting over Paul? Or
was she, perhaps, secure in Elizabeth's promise, and the pleasure of
having separated them? What would she think if she knew that
Elizabeth was even now waiting for him here in Cranston—waiting to
be married to him? But with this thought the spell of indifference
which had rested upon Elizabeth seemed suddenly to fall away, and
there swept over her a sudden sense of revolt, of shame and
repulsion. She started impulsively to her feet. No, she could not be
married—not in that way; it was clandestine, disgraceful. There was
still time to escape. If only she could reach home, without seeing
Paul! She made one quick, blinded rush for the door, and then, a tall
figure stood in her way, and her hands were seized in a man's eager
grasp. His handsome, exultant face looked into hers.
"My brave girl," he said. "So you have not failed me."
 Chapter XI

E with a great effort wrenched her hands away from Paul's

lizabeth
grasp, and fell against one of the marble-topped tables. Her face
was white, her dull eyes looked up at him with a sort of terror.
"I—I have failed you," she said, speaking slowly and thickly, with
parched lips. "I have come, but I—cannot stay. I was going when
you came in."
"Elizabeth!" The look of exultant joy faded slowly and reluctantly
from Paul's face. "Elizabeth, what do you mean? Why did you come
if you don't mean to stay?"
"Because I—was crazy." She was trembling now, and she clung to
the table for support; but still she was firm. "I—I didn't think what I
did. Now I—I know. It would be wrong to marry like this—so
secretly. I must go home. Let me pass." She spoke the last words
quickly, imperiously, and made a motion as if to brush past him; but
he stood motionless in the door and blocked her way.
He was very angry; she had never seen him so before. The emotion
lent a curious brute strength to his fair, sensuous beauty. His face
was as white as hers, his full red lips were set in a curve of
unwonted determination.
"Listen to me, Elizabeth." He had never spoken to her in such a tone
before. "I won't be trifled with like this. I have made all the
arrangements. I won't have you—jilt me now. You must come with
me, or I—I'll know the reason why."
She met his gaze defiantly. "You can't compel me to come you
know," she said. And again she would have passed him, and again
he stopped her. She did not try a third time, but sank into a chair
and put up her hands to her face. A sudden faintness came over
her; it might have been the heat, or the sharp, conflicting play of
emotion. He followed her and gently took her hands from her face
and looked into her eyes.
"Don't be foolish, darling," he said, persuasively. "You know that you
love me, that you are only playing with me. You wouldn't really
throw me over now."
She looked up reluctantly, fascinated as she had often been before,
by the mere physical attraction of his beauty. "I—I don't know," she
began slowly, and then stopped frightened at the sound of voices in
the shop. A dread flashed over her all at once of a scene in a place
like this. The trifling, frivolous consideration turned the scale in
Paul's favor. She rose, shook off his grasp, and gave a hasty glance
in the glass.
"No, I won't throw you over," she said. "It's all wrong but—as you
say, it's too late now. Take care—some one is coming." She gave a
warning look at the door, as Paul pressed her hand.
So the threatened scene was averted and Elizabeth's fate was
sealed. The people who, after buying candy in the shop, came into
the little back room for some ice cream, saw a young woman
arranging her hair before the glass, and a young man waiting for her
—a not unusual sight.
What followed seemed in after life a dream to Elizabeth. There were
times when she tried to think that it had never happened; that the
whole thing was a mere figment of the imagination. But on that day
she was quite conscious that it was she herself, in very flesh and
blood, Elizabeth Van Vorst, who walked by Paul Halleck's side
through the glaring, sunny streets of Cranston, went with him into a
dimly-lighted church, let him place a ring upon her finger, spoke her
share in the marriage service, and wrote her maiden name for what
should have been the last time, in the parish register. The clergyman
was very old and mumbled over the service; the witnesses, two
servants of his, were old and feeble, also, and took but small
interest. The church was damp like a tomb after the heat without;
Elizabeth found herself shivering as from a chill. It was a relief to
come out again into the heat which had been so oppressive before.
But on the church steps Elizabeth gave a little cry. A funeral was
slowly filing past, its black trappings standing out in incongruous
gloom against the noon-day brilliance.
Elizabeth looked at Paul. He had turned very white, and he too was
shivering. "It is a bad omen," he said, in a low voice, as if to himself.
He said no more, but led the way carefully in the opposite direction
from that which the funeral had taken.
They found themselves in a part of Cranston unknown to Elizabeth.
The road was bordered on either side by flowering hedges and led
apparently into the open country. There were no houses in sight; for
the moment, even no people. Halleck suddenly turned and clasped
Elizabeth almost roughly in his arms, while he pressed passionate
kisses upon her brow, her lips, her hair.
"My darling," he cried "I can't—I can't give you up. I was mad to
promise it. Let everything go and come with me to New York."
"No, no, I can't," she murmured faintly. "I can't." His vehemence
stunned, bewildered her; but instinctively she struggled against it.
"You promised," she cried out indignantly, "you promised that I
should be free—till you came back. I've kept my word, you must
keep yours."
He let her go and for a moment they eyed each other steadily. This
time the victory remained with her. "Did I really make that promise?"
he said at last with a sigh. "Well, if I did, I must keep it, I suppose.
But, Elizabeth, you must be made of ice—you can't love me, or you
wouldn't hold me to it."
Elizabeth was chiefly conscious of an overpowering sense of relief.
"I do love you," she said, soothingly, "but indeed it is better—much
better to let things be as we arranged them. I can't go to New York
in this dress"—she gave a little tremulous laugh, as she glanced at
her fluffy muslin skirts. "Only a man could suggest such a thing. And
then my aunts!—they would be distracted. No, no, I must go home
at once. You will be back in six months," she went on, trying to
console him. "They will pass very quickly."
"Six months," he sighed. "It is an endless time." He was the picture
of gloom as they turned and walked steadily back to the busy part of
Cranston. And she, too, had her regrets. The compromise was
satisfactory to neither.
At the corner of the High Street they parted. There was no
opportunity for more than a hand-clasp, a few hurried words of
farewell. Then he went his way to the railroad station, and she
hurried to the trolley. The country woman with the many parcels was
there before her, and told where she got the stockings, and how
much she paid for them.
Back again went the trolley, along the asphalted road past the
Queen Anne villas with their terraced gardens, past bicycles,
carriages, wagons, and always clouds of dust; out into the open
country, with rolling meadow and upland on either side, simmering
in the heat of the summer afternoon, to which the morning heat was
as nothing; Elizabeth sitting upright, shading her eyes from the
glare, with aching head and burning eyes, and throbbing brain that
refused to take in the reality of what she had done. This was her
wedding journey.
An hour later the white pony brought her home.
"Did you—did you match your ribbon, dear?" Miss Joanna inquired
anxiously. Elizabeth stared blankly for a moment.
"I—I never thought of the ribbon," she cried at last, and burst into
hysterical laughter.
 Chapter XII

I was that time of year when the Neighborhood, and the whole
t
riverside, are in their glory. Day after day dawned clear and frosty,
to warm at noon-day into a mellow brilliance. On every side
stretched wooded meadow and upland all aglow, resplendent in
varied tints of crimson and russet, magenta and scarlet, blending in
a glorious scheme of color, till they melted at last into the soft gray
haze, which rested, like a touch of regretful melancholy, on the tops
of the distant hills. Over the fields the golden-rod was still scattered
profusely, amidst the sober browns and purples of the bay, and the
pale lavender of the Michaelmas daisies. Red berries glistened on the
bushes, the ground was covered, every day deeper, with a carpeting
of fallen leaves and chestnut burrs.
On one of these autumn days, when the light was fading into dusk,
Mrs. "Bobby" Van Antwerp came to call at the Homestead, and
found no one at home but Elizabeth, who was kneeling on the
hearth-rug, staring into the fire.
Elizabeth's thoughts were not pleasant ones. She had refused to go
to Cranston with her aunts that afternoon, for she had never been
near the place since that hot July day, nearly three months before,
when she had forgotten to match her ribbon. What construction her
aunts placed upon the episode she never knew. They did not allude
to it in words, but treated her with added care and solicitude, as if
she were recovering from some illness. In pursuance of this theory,
they took her to a highly recommended and very dull seaside place,
where she was extremely bored. She returned in better health,
though hardly better spirits. She had now a new trouble, which
increased as the autumn advanced. Paul's letters, at first many and
ardent, grew fewer and colder, till they ceased altogether. Elizabeth's
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