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 Chapter 01: The History and Interviewing Process
Test Bank—Nursing

Test Bank for Seidels Guide to Physical Examination

8th Edition by Ball
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MULTIPLE CHOICE

1. The primary objective of the initial encounter is to:

a. define the advice and care for the patient.
b. establish the tone of a successful partnership.
c. optimize your ability to help.
d. tell the patient the limits of care.
ANS: B
The first meeting with the patient sets the tone for a successful partnership. It is to discover
the details about patients’ concerns, explore expectations for the encounter, display genuine
interest, and develop a partnership.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 1

OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care

2. If language is a barrier, the interpreter should be:

a. a family member.
b. a language board.
c. a professional interpreter
d. a staff person.
ANS: C
Someone other than a family member should act as an interpreter to bridge the language
difference between a health care provider and the patient. A professional interpreter rather
than a family member should be used.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 4

OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care

3. Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more
and does not hang around his friends, and recently his girlfriend broke up with him. Your
most immediate question is to ask Kyle:
a. “Do you want to see a counselor today?”
b. “Is your father out of jail yet?”
c. “Are you taking any illegal drugs?”
d. “Have you made plans to harm yourself?”
ANS: D
If you sense that a patient is contemplating suicide, you should ask about suicidal ideation
directly. The most important area to address is the potential for suicide. The question “Is your
father out of jail yet?” may be relevant to the history, but is not an immediate concern.
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 1
 DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 2

 4. Ms. Yale is a 52-year-old patient who presents to the office for evaluation. During the
interview, you say “Tell me what you do when you have knee pain.” The health care provider
is asking information about:
a. health promotion.
b. the description and character of the complaint.
c. the location and duration of the complaint.
d. aggravating and relieving factors of the complaint.
ANS: D
The health care provider is asking a symptom-analysis question to obtain more information
about the aggravating and alleviating factors of the knee pain. Asking the patient to describe a
typical attack of pain would help obtain information about the description and character of the
complaint. The question “When did you last feel well?” would help define the time of onset
and duration of the complaint. A question about health promotion would be directed toward
improving patient health.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 11

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

5. Which question would be considered a “leading question?”

a. “What do you think is causing your headaches?”
b. “You don’t get headaches often, do you?”
c. “On a scale of 1 to 10, how would you rate the severity of your headaches?”
d. “At what time of the day are your headaches the most severe?”
ANS: B
Stating to the patient that he or she does not get headaches would limit the information in the
patient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she would rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.

DIF: Cognitive Level: Applying (Application) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

6. To prevent personal appearance from becoming an obstacle in patient care, the health care
professional should:
a. wear a uniform.
b. avoid wearing white.
c. avoid extremes in dress.
d. avoid wearing any jewelry.
ANS: C
Sensible personal habits, along with avoidance of extremes in behavior and dress, contribute
to establishing a trusting relationship between the care provider and the patient.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 3

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 3

 7. Which action would best promote accurate translation and confidentiality when the caregiver
does not speak the patient’s language?
a. Ask a person unfamiliar with the patient to translate.
b. Have a friend of the patient translate.
c. Involve the family with the translation.
d. Use a neighbor as translator.
ANS: A
When you do not speak the patient’s language, family members or friends may pose a
communication barrier and may have issues of confidentiality; a stranger will be a less biased
interpreter. You should ask a person unfamiliar with the patient to translate.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

8. When are open-ended questions generally most useful?

a. During the initial part of the interview.
b. After several closed-ended questions have been asked.
c. While designing the genogram.
d. During the review of systems.
ANS: A
Asking open-ended questions at the beginning of an interview allows you to gather more
information and establishes you as an empathic listener, which is the first step of effective
communication. Interviewing for the purpose of designing a genogram or conducting a review
of systems requires more focused data than can be more easily gathered with direct
questioning. Asking closed-ended questions may stifle the patient’s desire to discuss the
history of the illness.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

9. Behaviors that diffuse anxiety during the interview include:

a. avoiding wearing uniforms or laboratory coats.
b. providing forthright answers to questions.
c. providing all necessary information before the patient has to ask for it.
d. completing the interview as quickly as possible.
ANS: B
To relieve anxiety, the health care professional should answer patient questions forthrightly,
should avoid an overload of information, and should not hurry the conversation. Uniforms, lab
coats, and scrub suits are common in health care. It is impossible to anticipate every question
that a patient may ask. Completing the interview as quickly as possible may make the patient
feel rushed.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 4

 10. Periods of silence during the interview can serve important purposes, such as:
a. allowing the clinician to catch up on documentation.
b. promoting calm.
c. providing time for reflection.
d. increasing the length of the visit.
ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning courage,
and displaying compassion. This is not a time to document in the chart, but rather to focus on
the patient. Periods of silence may cause anxiety rather than promote calm. The length of the
visit is less important than getting critical information.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

11. Which technique is most likely to result in the patient’s understanding of questions?
a. Use phrases that are commonly used by other patients in the area.
b. Use the patient’s own terms if possible.
c. Use the simplest language possible.
d. Use proper medical and technical terminology.
ANS: B
To ensure that your questions have been correctly understood, be clear and explicit while
using the patient’s own terms and level of understanding. Using phrases commonly used by
other patients may not help ensure that your questions have been correctly understood by this
patient. You should be clear and explicit while using the patient’s own terms and level of
understanding. Using the simplest language will not help ensure that your questions have been
correctly understood. It is important to avoid the use of medical terminology, because the
patient may not understand it.

DIF: Cognitive Level: Applying (Application) REF: p. 2

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

12. Mr. Franklin is speaking with you, the health care provider, about his respiratory problem.
Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell
me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why
I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate
for enhancing communication?
a. “After 3 days, you’re tired of coughing. Have you had a fever?”
b. “I’d like to hear more about your experiences. Where were you born?”
c. “I don’t know what’s wrong. You could have almost any disease.”
d. “I’ll examine you and figure out later what the problem is.”
ANS: A
“After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at
focusing on the chief compliant to gather more data and does not digress from the issue.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 5

 13. Mr. Miller is a 46-year-old patient who becomes restless during the history and says, “I don’t
have time for all of this conversation. I’ve got to get back to work.” Your most appropriate
response would be to:
a. remember (acknowledge) his anger and proceed with the history and examination.
b. ask another open-ended question and insist on an answer.
c. ask questions about his anger and move closer to him.
d. ignore his displeasure and become more assertive about getting answers.
ANS: A
Acknowledging his anger and proceeding with the history and examination is the only
response that resists the tendency for patient manipulation, pursues the information, and
confronts the anger.

DIF: Cognitive Level: Applying (Application) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

14. When you are questioning a patient regarding alcohol intake, she tells you that she is “only a
social drinker.” Which initial response is appropriate?
a. “I’m glad that you are a responsible drinker.”
b. “Do the other people in your household consume alcohol?”
c. “What amount and what kind of alcohol do you drink in a week?”
d. “If you only drink socially, you won’t need to worry about always having a
designated driver.”
ANS: C
“What amount and what kind of alcohol do you drink in a week?” clarifies the patient’s own
statement without asking a leading question or being judgmental.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 8

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

15. Ms. T is crying and states that her mother couldn’t possibly have a tumor. “No one else in the
family has ever had cancer!” exclaims the daughter. The most appropriate response to Ms. T
would be:
a. “Has anyone explained hospice care to your mother?”
b. “I’m so sorry that your mother was diagnosed with cancer.”
c. “That is odd, since cancer usually runs in families.”
d. “Why do you think that your mother’s tumor is cancerous?”
ANS: D
“Why do you think that your mother’s tumor is cancerous?” is the only answer that is a direct
exploration of the daughter’s concern. The health care provider can address and clarify the
concerns of the daughter.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 6

 16. After you ask a patient about her family history, she says, “Tell me about your family now.”
Which response is generally most appropriate?
a. Ignore the patient’s comment and continue with the interview.
b. Give a brief, undetailed answer.
c. Ask the patient why she needs to know.
d. Tell the patient that you do not discuss your family with patients.
ANS: B
Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without
invading your private life. Ignoring the patient’s comment, continuing with the interview, and
telling the patient that you do not discuss your family with patients will potentially anger or
frustrate her and keep her from sharing openly. Asking the patient why she needs to know will
distract from the real reason she is seeking care and instead move the interview conversation
away from the topics that should be discussed.

DIF: Cognitive Level: Applying (Application) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

17. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She
seems nervous as she speaks to you. An appropriate response is to:
a. continue to collect information regarding the chief complaint in an unhurried
manner.
b. finish the interview as rapidly as possible.
c. ask the patient to take a deep breath and calm down.
d. ask the patient if she wants to wait until another day to talk to you.
ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will
communicate caring to the patient. If you as the health care provider are hurried, the patient
will be more anxious. The best way to assist an anxious patient is to not hurry and remain
calm, because this will communicate caring to the patient. Asking the patient if she wants to
wait until another day to talk to you delays the needed health care.

DIF: Cognitive Level: Applying (Application) REF: p. 4

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 7

 18. Ms. A states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one
of the following statements is the most appropriate caregiver response?
a. “Try to think about the good things in life.”
b. “What in life is causing you such pain?”
c. “You can’t mean what you’re saying.”
d. “If you think about it, nothing is worth getting this upset about.”
ANS: B
Specific but open-ended questions are best used when the patient has feelings of loss of
self-worth and depression. “Try to think about the good things in life,” “You can’t mean what
you’re saying,” and “If you think about it, nothing is worth getting this upset about” are
statements that will hurry the patient and offer only superficial assurance.

DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 4-6

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

19. During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially,
you should:
a. ask him if he would like some time alone.
b. offer a tissue and let him know it is all right to cry.
c. explain to the patient that you will be able to help him more if he can control his
emotions.
d. ask the patient what he is upset about.
ANS: B
When patients cry, it is best to allow the moment to pass at the patient’s pace. If you suspect a
need to cry but the patient is suppressing it, give permission. Asking him if he would like
some time to himself will leave the patient alone during a time of sad feelings. Explaining to
the patient that you will be able to help him more if he can control his emotions will shut
down the patient’s emotions. Asking the patient what he is upset about will not give the
patient time to cry and express his emotions.

DIF: Cognitive Level: Applying (Application) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 8

 20. During an interview, you have the impression that a patient may be considering suicide.
Which action is essential?
a. Ask whether the patient has considered self-harm.
b. Avoid directly confronting the patient regarding your impression.
c. Ask whether the patient would like to visit a psychiatrist.
d. Record the impression in the patient’s chart and refer the patient for
hospitalization.
ANS: A
If you think the patient may be considering suicide, he or she probably is. Mentioning it gives
permission to talk about it. Do not avoid directly confronting the patient regarding your
impression. It is important to confront the suicidal thoughts. Asking whether the patient would
like to visit a psychiatrist does not allow the patient to talk about the suicidal thoughts before
you determine that she or he needs a specialist level of care. Recording the impression in the
patient’s chart and referring the patient for hospitalization does not collaborate with the
patient and does not give him or her permission to talk about the thoughts of self-harm.

DIF: Cognitive Level: Applying (Application) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

21. During a history-taking session, Mr. B appears to be avoiding certain questions. He keeps
looking out the window. What should the caregiver do?
a. Ask direct questions and insist on a “yes” or “no” answer to each question.
b. Continue to ask questions until Mr. B responds appropriately.
c. Make a note to pursue sensitive issues later in the interview.
d. Stop the interview until the patient is ready to cooperate.
ANS: C
When the patient dissembles, do not push too hard for an answer. Allow the interview to go
on and come back to the questions he avoided answering later. Yes or no questions will close
the interview process. Continue with the interview, making a note to return to questioning
about that issue later in the interview. Continuing to ask questions until Mr. B responds
appropriately will not allow the patient time to reflect and answer. Stopping the interview
until the patient is ready to cooperate will stop the flow of communication.

DIF: Cognitive Level: Applying (Application) REF: p. 5

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 9

 22. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they should
be:
a. given the opportunity to be interviewed without the parent at some point during
the interview.
b. mailed a questionnaire in advance to avoid the need for them to talk.
c. ignored while you address all questions to the parent.
d. allowed to direct the flow of the interview.
ANS: A
The older child should be given the opportunity to give information directly. This enhances
the probability that the child will follow your advice. Mailing a questionnaire in advance to
avoid the need for her to talk does not assist the child in learning to respond to answers
regarding her health. The parent can help fill in gaps at the end. If she is ignored while you
address all questions to the parent, the patient will feel as though she is just being discussed
and is not part of the process for the health care. The health care provider should always direct
the flow of the interview according to the patient’s responses.

DIF: Cognitive Level: Applying (Application) REF: p. 16

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

23. Information that is needed during the initial interview of a pregnant woman includes all the
following except:
a. the gender that the woman hopes the baby will be.
b. past medical history.
c. health care practices.
d. the woman’s remembering (knowledge) about pregnancy.
ANS: A
The initial interview for the pregnant woman should include information about her past
medical history, assessment of health practices, identification of potential risk factors, and
assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is
not as important as the information about her past medical history, health care practices, and
the woman’s remembering (knowledge) about her pregnancy.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 17

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

24. When communicating with older children and teenagers, you should be sensitive to their:
a. desire for adult companionship.
b. natural urge to communicate.
c. need for verbal instructions.
d. typical reluctance to talk.
ANS: D
Adolescents are usually reluctant to talk; therefore the provider should clearly communicate a
respect for confidentiality.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 16

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 10

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 25. When interviewing older adults, the examiner should:
a. speak extremely loudly, because most older adults have significant hearing
impairment.
b. provide a written questionnaire in place of an interview.
c. position himself or herself facing the patient.
d. dim the lights to decrease anxiety.
ANS: C
The health care provider should position himself or herself so that the older patient can see his
or her face. Shouting distorts speech, dimming the lights impairs vision, and a written
interview may be necessary if all else fails.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 18

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

26. When you suspect that your 81-year-old patient has short-term memory loss because he
cannot remember what he had for breakfast, you should:
a. order a neurology consult.
b. stop all of his medications.
c. validate the concern with his family or caregivers.
d. dismiss the finding as a normal age-related change.
ANS: C
When older adults experience memory loss for recent events, consult other family members to
clarify discrepancies or to fill in the gaps. You may want to consult neurology later, but to
assess the memory loss, you need validation of the patient’s responses. Stopping medications
will not identify the short-term memory loss. Short-term memory loss is not an age-related
change.

DIF: Cognitive Level: Applying (Application) REF: p. 19

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

27. To what extent should the patient with a physical disability or emotional disorder be involved
in providing health history information to the health professional?
a. The patient should be present during information collection but should not be
addressed directly.
b. All information should be collected from past records and family members while
the patient is in another room.
c. The patient should be involved only when you sense that he or she may feel
ignored.
d. The patient should be fully involved to the limit of his or her ability.
ANS: D
Patients who are disabled may not give an effective history, but they must be respected, and
the history must be obtained from them to the greatest extent possible. Patients should be
addressed directly and participate in the interview to the extent of their ability.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 20

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 11

 28. A brief statement of the reason the patient is seeking health care is called the:
a. medical history.
b. chief complaint.
c. assessment.
d. diagnosis.
ANS: B
The chief complaint is a brief statement of why the patient is seeking health care. The medical
history, assessment, and diagnosis are not the reasons that the patient is seeking health care.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 10

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

29. A pedigree diagram is drafted for the purpose of obtaining:

a. sexual orientation and history.
b. growth and developmental status.
c. genetic and familial health problems.
d. ethnic and cultural backgrounds.
ANS: C
A pedigree diagram, or genogram, shows consanguinity of health problems. Sexual
orientation and history are noted in the review of systems (ROS). Growth and development
are plotted on a percentile chart. Ethnic and cultural backgrounds are noted in the family
history.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

30. When taking a history, you should:

a. ask the patient to give you any information they can recall about their health.
b. start the interview with the patient’s family history.
c. use a chronologic and sequential framework.
d. use a holistic and eclectic structure.
ANS: C
To give structure to the present problem or chief complaint, the provider should proceed in a
chronologic and sequential framework. Asking patients to give you any information they can
recall about their health and using a holistic and electric structure do not provide structure to
the history. Gathering the patient’s family history is only the first step.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 11

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 12

 31. When questioning the patient regarding his or her sexual history, which question should be
asked initially?
a. “Do you have any particular sexual likes or dislikes?”
b. “Do you have any worries or concerns regarding your sex life?”
c. “How often do you have intercourse and with whom?”
d. “Do you have any reason to think you may have been exposed to a sexually
transmitted infection?”
ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider
first ask open-ended questions that explore the patient’s feelings about the issue. “Do you
have any particular sexual likes or dislikes?” is not a question that should be asked in an
interview regarding sexual history. “How often do you have intercourse and with whom?” and
“Do you have any reason to think you may have been exposed to a sexually transmitted
infection?” are not questions that should be asked initially in an interview regarding the
patient’s sexual history.

DIF: Cognitive Level: Applying (Application) REF: p. 10

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

32. A guideline for history taking is for caregivers to:

a. ask direct questions before open-ended questions so that data move from simple
to complex.
b. ask for a complete history at once so that data are not forgotten between meetings.
c. make notes sparingly so that the patient can be observed during the history taking.
d. write detailed information as stated by patients so that their priorities are
reflected.
ANS: C
During the interview, you should maintain eye contact with the patient, observing body
language and proceeding from open-ended to direct questions. Asking direct questions first
may upset the patient. During the interview you should gather as much information as you
need for the current reason the patient is seeking health care. It is important to focus on the
patient. Brief notes can be charted, but you should maintain eye contact with the patient,
observing body language and proceeding from open-ended to direct questions.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 13

 33. Mr. D complains of a headache. During the history, he mentions his use of alcohol and illicit
drugs. This information would most likely belong in the:
a. chief complaint.
b. past medical history.
c. personal and social history.
d. review of systems.
ANS: C
Habits are included within the personal and social history. The chief complaint is the reason
the patient is seeking health care. The past medical history is made up of the previous medical
conditions that the patient has had. The review of systems is an overview of problems with
other body systems.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

34. Direct questioning about domestic violence in the home should be:
a. a routine component of history taking with female patients.
b. avoided for fear of offending the woman’s partner.
c. conducted only in cases in which there is a history of abuse.
d. used only when the patient is obviously being victimized.
ANS: A
The presence of domestic violence should be routinely queried, and the questioning should be
direct for all female patients. Direct questioning about domestic violence in the home should
not be avoided for fear of offending the woman’s partner, should be part of a routine
examination, and should not be used only when the patient is obviously being victimized.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 9

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

35. Mrs. G reports an increase in her alcohol intake over the past 5 years. To screen her for
problem drinking, you would use the:
a. CAGE questionnaire.
b. PACES assessment.
c. Miller Analogies Test.
d. Glasgow Coma Scale.
ANS: A
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol.
PACES is used to screen adolescents for important issues in their life. The Miller Analogies
Test is used is used to test cognitive functioning. The Glasgow Coma Scale is a neurology
assessment.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 8

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 14

 36. A tool used to screen adolescents for alcoholism is the:
a. CAGE.
b. CRAFFT.
c. PACES.
d. HITS.
ANS: B
The CRAFFT tool is used to screen for alcoholism in adolescents. The CAGE test is used to
screen for alcoholism in adults. PACES is used to screen adolescents for important issues in
their life. HITS is the screen for domestic violence.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 8

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

37. When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s
lap. She turns away from you when you greet her. Initially, your best response is to:
a. leave the child sitting in the father’s lap while you talk to the father.
b. ask the child to be seated on the examination table so that you can talk to her
father.
c. explain to the child that you will not hurt her and that she will have to trust you.
d. ask the father to persuade the child to cooperate with you.
ANS: A
Interaction with children must be modified according to the child’s age and in a manner that
promotes trust.

DIF: Cognitive Level: Applying (Application) REF: p. 14

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

38. Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems
unconcerned about any consequences of his activities. Which factor is typical of adolescence
and pertinent to Tom’s health?
a. Attachment to parents
b. High self-esteem
c. Low peer support needs
d. Propensity for risk taking
ANS: D
Adolescents tend to experiment with risky behaviors that can lead to a high incidence of
morbidity and mortality.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 16

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 15

 39. Pain is difficult to assess in older adults because:
a. drugs act more rapidly with age.
b. their language skills decline.
c. they tend to exaggerate symptoms.
d. sharp pain may be felt as a dull ache.
ANS: D
Pain is often an unreliable symptom in older adults because they lose pain perception and
experience pain in a different manner than those of other age groups. Older adults tend to
think pain in aging is normal.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 19

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

40. Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health
promotion. A survey of mobility and activities of daily living (ADLs) is part of a(n):
a. ethnic assessment.
b. functional assessment.
c. genetic examination.
d. social history.
ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement,
household management, ADLs, and instrumental activities of daily living (IADLs).

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 19

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

41. Constitutional symptoms in the ROS refer to:

a. height, weight, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.
ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep
patterns, and weight (average, preferred, present, change).

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 13

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 16

 42. JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of
acute sinusitis. The type of history that is warranted is a(n) history.
a. complete
b. inventory
c. problem or focused
d. interim
ANS: C
If the patient is well known, or if you have been seeing the patient for the same problem over
time, a focused history is appropriate. A complete history is only obtained during initial visits
or during a complete history and physical examination (H&P). An inventory is related to but
does not replace the complete history. It touches on the major points without going into detail.
This is useful when the entire history taking will be completed in more than one session. An
interim history is only obtained during a return of the patient after several months of absence.

DIF: Cognitive Level: Applying (Application) REF: p. 20

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

MULTIPLE RESPONSE

1. Which of the following are connection types of communication? (Select all that apply.)
a. Poor self image
b. Good eye contact
c. Avoiding being judgmental
d. Ensuring good lighting
e. Respecting silence
f. Ensure confidentiality
ANS: B, C, E
Poor self-image, ensuring good lighting, and ensuring confidentiality are not connection types
of communications; good eye contact, avoiding being judgmental, and respecting silence are
connections to communication.

DIF: Cognitive Level: Applying (Application) REF: p. 3

OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

Copyright © 2015 by Mosby, an imprint of Elsevier Inc. 17

Exploring the Variety of Random
Documents with Different Content
reality some eight or ten years in advance of that age: his form, of
medium stature, was symmetrical, erect, and closely knit, betraying
considerable capability of endurance, though but little of muscular
strength: his countenance, at first sight, was by no means
prepossessing; indeed, the features, while in repose, presented an
aspect harsh—almost forbidding; but, when lighted up by animation,
there was discoverable in their rapid play a mildness which well
compared with the benevolent expression of a soft blue eye. Such
was the physique of my backwoods pioneer, who for forty years had
been a wanderer on the outskirts of civilization, and had at length
been overtaken by its rapid march.
As I had before me but an easy ride for the day, I proposed to mine
host, when our repast was over, that he should accompany me to
the summit of the range of bluffs which rose behind his cabin,
towering to the height of several hundred feet above the roof. To
this he readily assented, and well did 208 the magnificent view
commanded from the top compensate for the toil of the ascent. The
scene was grand. "Yonder," said my companion, seating himself on
the earth at my side, and stretching out his arm to the southeast,
"yonder lies the village of old Kaskaskia, with the bluffs of the river
beyond, rising against the sky; while a little to the left you catch the
white cliffs of Prairie du Rocher. In that heavy timber to the south
are the ruins of Fort Chartres, and to the right, across the lake, fifty
years ago stood St. Philippe. The Mississippi is concealed from us,
but its windings can be traced by the irregular strip of forest which
skirts its margin. Beyond the stream, stretching away to the
northwest, the range of heights you view are the celebrated cornice-
cliffs[66] above Herculaneum; and at intervals you catch a glimpse of
a shot-tower, resting like a cloud against the sky, upon the tallest
pinnacles. The plain at our feet, which is now sprinkled with
cornfields, was once the site of an Indian village. Forty years ago,
the ruins of the wigwams and the dancing circle surrounding the
war-post could be distinctly traced out: and even now my
ploughshare every spring turns up articles of pottery which
constituted their domestic utensils, together with axes and mallets of
stone, spear and arrow heads and knives of flint, and all their rude
instruments of war. Often of a fine evening," continued my
companion, after a pause, "when my work for the day is over, and
the sun is going down 209 in the west, I climb up to this spot and
look out over this grand prospect; and it almost makes me sad to
think how the tribes that once possessed this beautiful region have
faded away. Nearly forty years ago, when I came with my father
from old Virginia, this whole state, with its prairies, and forests, and
rich bottoms, was the hunting-ground of the Indians. On this spot
we built our cabin; and though I have since lived far off on the
outskirts of the Missouri frontier, I always had an affection for this
old bottom and these bluffs, and have come back to spend here the
rest of my days. But the Indians are gone. The round top of every
bluff in yonder range is the grave of an Indian chief."
While my singular companion was making these observations,
somewhat in the language I have attempted to give, interrupted
from time to time by my inquiries, I had myself been abstractedly
employed in thrusting a knife which was in my hand into the yielding
mould of the mound upon which we sat, when, suddenly, the blade,
striking upon a substance somewhat harder than the soil, snapped
into fragments. Hastily scraping away the loose mould to the depth
of some inches, the femur of a human skeleton protruding from the
soil was disinterred, and, in a few minutes, with the aid of my
companion, the remnants of an entire skeleton were laid bare.
Compared with our own limbs, the bones seemed of a size almost
gigantic; and from this circumstance, if from no other, it was evident
that our melancholy moralizing upon the destinies of the Indians had
been indulged upon a very fitting spot— 210 the grave of one of its
chieftains. Originally, the body had no doubt been covered to the
depth of many feet, and the shallowness of soil at the present time
indicates a lapse of centuries. Still these graves of the bluffs, which
doubtless belonged to the ancestors of the present aborigines, will
neither be confounded nor compared with the gigantic earth-heaps
of the prairies. Strangely enough, this has been the case, though a
moment's reflection must convince one that they are the monuments
of a far later race.
Descending the bluffs by an ancient path in a ravine, said to have
been made in conveying oak timber to Fort Chartres at the period of
its erection, my host conducted me into one of the enclosures of his
farm, a spot which had evidently once been the ordinary burial-place
of the ancient Indian village. Graves, sufficient, apparently, for
hundreds of individuals, were yet to be seen upon every side. They
were arranged parallel to each other in uniform ranges, and were
each formed by a rough slab of limestone upon either side, and two
at the extremities, terminating in an obtuse angle. From several of
these old sepulchres we threw out the sand, and, at the depth of
about four feet, exhumed fragments of human remains in various
stages of preservation, deposited upon a broad slab of limestone at
the bottom. When taken together, these slabs form a complete coffin
of stone, in which the body originally reposed; and this
arrangement, with the silicious nature of the soil, has probably
preserved the remains a longer period than would otherwise have
been the case. But the circumstance respecting 211 these ancient
graves which chiefly excited my astonishment was their marvellous
littleness, none of them exceeding a length of four feet; and the
wondrous tales of a "pigmy race of aborigines" once inhabiting the
West, which I had often listened to, recurred with considerable force
to my memory. Resolved to decide this long-mooted question to my
own satisfaction, if possible, the earth from one of the graves, the
most perfect to be found, was excavated with care, and upon the
bottom were discovered the femur and tibia of a skeleton in a state
of tolerable preservation, being parallel to each other and in
immediate proximity. Proof incontestible, this, that the remains were
those of no Lilliputian race four feet in stature, and affording a fair
presumption that the limbs were forcibly bent in this position at the
time of burial, occupying their stone coffin much as the subject for
scientific dissection occupies a beef-barrel. In this manner may we
satisfactorily account for the ancient "pigmy cemetery" near the
town of Fenton, on the Merrimack in Missouri, as well as that on the
Rivière des Pères, in the same vicinity, already referred to, and those
reported to exist in various other sections of the West, in which,
owing to the dampness of the soil, the remains have been long
resolved to dust, and only the dimensions of the grave have
remained.[67]
Among the articles which my host had procured from these old
graves, and deemed worthy of preservation, was a singular species
of pottery, composed, as appeared from its fracture, of shells
calcined and pulverized, mixed with an equal quantity 212 of clay,
and baked in the sun. The clay is of that fine quality with which the
waters of the Missouri are charged. The vessels are found moulded
into a variety of forms and sizes, capable of containing from a quart
to a gallon.[68] One of these, which my host insisted upon hanging
upon the bow of my Spanish saddle as I mounted, was fashioned in
the shape of a turtle, with the form and features very accurately
marked. The handle of the vessel, which was broken off, once
formed a tapering tail to the animal, presenting a rare specimen of a
turtle with that elegant appendage.
Ascending the bluffs by a tortuous though toilsome pathway through
the ravines, my route for some miles wound away through a sparse
growth of oaks, and over a region which seemed completely
excavated into sink-holes. Some of these tunnel-shaped hollows
were several hundred feet in diameter, and of frightful depth, though
of regular outline, as if formed by the whirl of waters subsiding to
the level of the plain beneath. They were hundreds in number, yet
each was as uniformly circular as if excavated by scientific skill. I
have met with none so regular in outline, though I have seen many
in the course of my journeyings.
The puissant little village of Waterloo furnished me a very excellent
dinner, at a very excellent tavern. The town appeared, from a hasty
view in passing through its streets, remarkable for nothing so much
as for the warlike soubriquet attached to it, if we except a huge
windmill, which, 213 like a living thing, flings abroad its gigantic
arms, and flaunts its ungainly pinions in the midst thereof. The
place, moreover, can boast a courthouse, indicative of its judicial
character as seat of justice for the county of Monroe; and, withal, is
rather pleasantly located than otherwise. About five miles north of
the village is situated a large spring, and a settlement called
Bellefontaine. This spot is celebrated as the scene of some of the
bloodiest atrocities of the Kickapoo Indians and predatory bands of
other tribes some fifty years since. Many of the settlers were killed,
and others carried into a captivity scarce to be preferred.[69]
An evening ride of a dozen miles, interesting for nothing but a
drenching shower, succeeded by a glare of scorching sunshine,
which, for a time, threatened perfect fusion to the traveller, or, more
properly, an unconditional resolution into fluidity; such an evening
ride, under circumstances aforesaid, brought me at sunset to the
town of Columbia, a place, as its name denotes, redolent of
patriotism.[70] "Hail Columbia!" was the exhilarated expression of my
feelings, if not of my lips, as I strode across the threshold of a log-
cabin, the appurtenance of a certain worthy man with one leg and
the moiety of another, who united in his calling the professions of
cobbler and publican, as intimated by the sign-board over his door.
Hail Columbia! All that it is possible to record touching this patriotic
village seems to be that it adds one more to the five hundred
previous villages of the selfsame appellation scattered over the land,
whose chief 214 consequence, like that of a Spanish grandee, is
concentrated and consists in a title. Every county of almost every
state of the Union, it is verily believed, can boast a Columbia.
Indeed, the name of the Genoese seems in a fair way of being
honoured as much as is that of George Washington; a distinction we
are sure to find bestowed upon every bullet-pated, tow-haired little
rascal, who, knowing not who his father was, can claim no
patronymic less general, having been smuggled into the world
nobody can tell when or how: George Washington, "Father of his
country," indeed, if the perpetration of a very poor pun on a
venerated name may be pardoned.
The earliest peep of dawn lighted me into the saddle; for, with the
unhappy Clarence, feelingly could I ejaculate,

"Oh, I have pass'd a miserable night!"

In sober sadness, sleep, gentle sleep, had visited not my eyes, nor
slumber mine eyelids; though, with the faith of a saint and the
perseverance of a martyr, I had alternated from bed to board and
from board to bed. And throughout that livelong night, be it
recorded, even until the morning dawned, did a concert of
whippoorwills and catydids keep up their infernal oratorio, seemingly
for no other reason than for my own especial torment; until, sinner
as I am, I could not but believe myself assoilzed of half the
peccadilloes of a foregone life. Happy enough to find myself once
more in the saddle, the morning breeze, as I cantered through the
forest, fanned 215 freshly a brow fevered by sleeplessness and
vexation. The early beams of the day-god were flinging themselves
in lengthened masses far athwart the plains at my feet as I stood
upon the bluffs. Descending, I was once more upon the American
Bottom.[71] This name, as already stated, was a distinction
appropriated to that celebrated tract so long since as when it
constituted the extreme limit in this direction of the Northwestern
Territory. Extending northwardly from the embouchure of the
Kaskaskia to the confluence of the great rivers, a distance of about
one hundred miles, and embracing three hundred thousand acres of
land, of fertility unrivalled, it presents, perhaps, second only to the
Delta of Egypt, the most remarkable tract of country known. Its
breadth varies from three miles to seven. Upon one side it is
bounded by a heavy strip of forest a mile or two deep, skirting the
Mississippi; and upon the other by an extended range of bluffs, now
rising from the plain in a mural escarpment of several hundred feet,
as at the village of Prairie du Rocher, and again, as opposite St.
Louis, swelling gracefully away into rounded sand-heaps,
surmounted by Indian graves. At the base of the latter are
exhaustless beds of bituminous coal, lying between parallel strata of
limestone.[72] The area between the timber-belt and the bluffs is
comprised in one extended meadow, heaving in alternate waves like
the ocean after a storm, and interspersed with island-groves,
sloughs, bayous, lagoons, and shallow lakes. These expansions of
water are numerous, and owe their origin 216 to that geological
feature invariable to the Western rivers—the superior elevation of
the immediate bank of the stream to that of the interior plain. The
subsidence of the spring-floods is thus precluded; and, as the
season advances, some of the ponds, which are more shallow,
become entirely dry by evaporation, while others, converted into
marshes, stagnate, and exhale malaria exceedingly deleterious to
health. The poisonous night-dews caused by these marshes, and the
miasm of their decomposing and putrefying vegetation, occasion,
with the sultriness of the climate, bilious intermittents, and the far-
famed, far-dreaded "fever and ague," not unfrequently terminating
in consumption. This circumstance, indeed, presents the grand
obstacle to the settlement of the American Bottom. It is one,
however, not impracticable to obviate at slight expense, by the
construction of sluices and canals communicating with the rivers,
and by the clearing up and cultivation of the soil. The salubrious
influence of the latter expedient upon the climate has, indeed, been
satisfactorily tested during the ten or twelve years past; and this
celebrated alluvion now bids fair, in time, to become the garden of
North America. A few of its lakes are beautiful water-sheets, with
pebbly shores and sparkling waves, abounding with fish. Among
these is one appropriately named "Clear Lake," or the Grand Marais,
as the French call it, which may be seen from St. Louis of a bright
morning, when the sunbeams are playing upon its surface, or at
night when the moon is at her full. The 217 earliest settlements of
the Western Valley were planted upon the American Bottom, and the
French villagers have continued to live on in health among the
sloughs and marshes, where Americans would most assuredly have
perished. Geologically analyzed, the soil consists of a silicious or
argillaceous loam, as sand or clay forms the predominating
constituent. Its fertility seems exhaustless, having continued to
produce corn at an average of seventy-five bushels to the acre for
more than a hundred years in succession, in the neighbourhood of
the old French villages, and without deterioration. Maize seems the
appropriate production for the soil; all of the smaller grains, on
account of the rank luxuriance of their growth, being liable to blast
before the harvesting.
Cahokia, Ill.
 XLI
"Gramercy, Sir Traveller, it marvels me how you can carry
between one pair of shoulders the weight of your heavy
wisdom. Alack, now! would you but discourse me of the
wonders you saw ayont the antipodes!"
"Peace, ignoramus! 'tis too good for thy ass's ears to listen to.
The world shall get it, caxtonized in a great book."—Traveller and
Simpleton.

"Farewell! a word that must be, and hath been;

A sound which makes us linger—yet—farewell!"
Childe Harold's Pilgrimage.

Of the alluvial character of the celebrated American Bottom there

can exist no doubt. Logs, shells, fragments of coal, and pebbles,
which have been subjected to the abrasion of moving water, are
found at a depth of thirty feet from the surface; and the soil
throughout seems of unvarying fecundity. Whether this alluvial
deposition is to be considered the result of annual floods of the river
for ages, or whether the entire bottom once formed the bed of a
vast lake, in which the waters of the Mississippi and Missouri mingled
on their passage to the Gulf, is a question of some considerable
interest. The latter seems the more plausible theory. Indeed, the
ancient existence of an immense lake, where now lies the American
Bottom, upon the east side of the Mississippi, and the Mamelle
Prairie upon the west side, extending seventy 219 miles northwardly
from the mouth of the Missouri where the Bottom ends, appears
geologically demonstrable. The southern limit of this vast body of
water seems to have been at that remarkable cliff, rising from the
bed of the Mississippi about twenty miles below the outlet of the
Kaskaskia, and known as the "Grand Tower." There is every
indication from the torn and shattered aspect of the cliffs upon
either side, and the accumulation of debris, that a grand parapet of
limestone at this point once presented a barrier to the heaped-up
waters, and formed a cataract scarcely less formidable than that of
Niagara. The elevation of the river by this obstacle is estimated at
one hundred and thirty feet above the present ordinary water-mark.
For more than an hundred miles before reaching this point, the
Mississippi now rolls through a broad, deep valley, bounded by an
escarpment of cliffs upon either side; and, wherever these present a
bold façade to the stream, they are grooved, as at the cornice-rocks,
by a series of parallel lines, distinctly traced and strikingly uniform.
As the river descends, these water-grooves gradually rise along the
heights, until, at the Grand Tower, they attain an altitude of more
than an hundred feet; below this point the phenomenon is not
observed.[73] This circumstance, and the disruption of the cliffs at
the same elevation, clearly indicate the former surface of the lake.
Organic remains, petrifactions of madrepores, corallines, concholites,
and other fossil testacea, are found imbedded in a stratum 220
nearly at the base. Similar phenomena of the water-lines exist upon
the cliffs of the Ohio, and a barrier is thought once to have
obstructed the stream at a point called the Narrows, sixty miles
below Louisville, with the same result as upon the Mississippi. The
eastern boundary of the expansion of the latter stream must have
been the chain of bluffs now confining the American Bottom in that
direction, and considered a spur of the Ozark Mountains. This
extends northeasterly to the "confluence;" thence, bending away to
the northwest, it reaches the Illinois, and forms the eastern bank of
that river. Upon the western side, the hills along the Missouri are
sufficiently elevated to present a barrier to the lake until they reach
the confluence of the rivers. At this point spreads out the Mamelle
Prairie, sixty or seventy miles in length, and, upon an average, five
or six in breadth. West of this plain, the lake was bounded by the
range of bluffs commencing with the celebrated "Mamelles," and
stretching north until they strike the river; while the gradual
elevation of the country, ascending the Upper Mississippi, presented
a limit in that direction.
The event by which this great lake was drained appears to have
been of a character either convulsive or volcanic, or to have been
the result of the long-continued abrasion of the waters, as at
Niagara. The rocks at the Grand Tower are limestone of secondary
formation—the stratum being several hundred feet in depth, and
imbedding hornstone and marine petrifactions throughout. They 221
everywhere exhibit indications of having once been subjected to the
attrition of rushing water, as do the cliffs bounding the Northern
lakes, which have long been chafed by the waves. The evidence of
volcanic action, or violent subterranean convulsion of some kind,
caused by heat, seems hardly less evident. The former workings of a
divulsive power of terrific energy is betrayed, indeed, all over this
region. In the immediate vicinity of the Grand Tower, which may be
considered the scene of its most fearful operations, huge masses of
shattered rock, dipping in every direction, are scattered about; and
the whole stratum for twenty miles around lies completely broken
up. At the point in the range of bluffs where this confusion is
observed to cease, the mural cliff rises abruptly to the altitude of
several hundred feet, exhibiting along the façade of its summit deep
water-lines and other evidence of having once constituted the
boundary of a lake. At the base issues a large spring of fresh water,
remarkable for a regular ebb and flow, like the tides of the ocean,
once in twenty-four hours.[74] At this spot, also, situated in the
southeastern extremity of St. Clair county, exists an old American
settlement, commenced a century since, and called the "Block-
house," from the circumstance of a stoccade fort for defence against
the 222 Indians.[75] By a late geological reconnoissance, we learn
that, from this remarkable tide-spring until we reach the Grand
Tower, the face of the country has a depressed and sunken aspect,
as if once the bed of standing water; and was evidently overlaid by
an immense stratum of calcareous rock. A hundred square miles of
this massive ledge have, by some tremendous convulsion of Nature,
been thrown up and shattered in fragments. The confused
accumulation of debris is now sunken and covered with repeated
strata of alluvial deposite. Evidence of all this is adduced from the
circumstance that huge blocks of limestone are yet frequently to be
encountered in this region, some of them protruding twenty or thirty
feet above the surface. As we approach the Grand Tower—that
focus, around which the convulsed throes of Nature seem to have
concentrated their tremendous energy—the number and the
magnitude of these massive blocks constantly increase, until, at that
point, we behold them piled up in mountain-masses as if by the
hand of Omnipotent might. Upon all this vast Valley of the West the
terrible impress of Almighty power seems planted in characters too
deep to be swept away by the effacing finger of time. We trace them
not more palpably in these fearful results of the convulsions of
Nature, agonized by the tread of Deity, than in the eternal flow of
those gigantic rivers which roll their floods over this wreck of
elements, or in those ocean-plains which, upon either side, in billowy
grandeur heave away, wave after wave, till lost in the magnificence
of 223 boundless extent. And is there nothing in those vast
accumulations of organic fossils—spoils of the sea and the land—the
collected wealth of the animal, vegetable, and mineral worlds,
entombed in the heart of the everlasting hills—is there naught in all
this to arouse within the reflecting mind a sentiment of wonder, and
elicit an acknowledgment to the grandeur of Deity? Whence came
these varied productions of the land and sea, so incongruous in
character and so diverse in origin? By what fearful anarchy of
elements were they imbedded in these massive cliffs? How many
ages have rolled away since they were entombed in these
adamantine sepulchres, from which Nature's convulsive throes in
later times have caused the resurrection? To such inquiries we
receive no answer. The secrecy of untold cycles veils the reply in
mystery. The effect is before us, but the cause rests alone with
Omniscience.
How wonderful are the phenomena betrayed in the geological
structure of our earth! And scarcely less so are the ignorance and
the indifference respecting them manifested by most of our race. "It
is marvellous," says the celebrated Buckland,[76] "that mankind
should have gone on for so many centuries in ignorance of the fact,
which is now so fully demonstrated, that so small a part of the
present surface of the earth is derived from the remains of animals
that constituted the population of ancient seas. Many extensive
plains and massive mountains form, as it were, the great charnel-
houses of preceding generations, in which the petrified exuviæ 224
of extinct races of animals and vegetables are piled into stupendous
monuments of the operations of life and death during almost
immeasurable periods of past time." "At the sight of a spectacle,"
says Cuvier,[77] "so imposing, so terrible as that of the wreck of
animal life, forming almost the entire soil on which we tread, it is
difficult to restrain the imagination from hazarding some conjectures
as to the cause by which such great effects have been produced."
The deeper we descend into the strata of the earth, the higher do
we ascend into the archæological history of past ages of creation.
We find successive stages marked by varying forms of animal and
vegetable life, and these generally differ more and more widely from
existing species as we go farther downward into the receptacle of
the wreck of more ancient creations.
That centuries have elapsed since that war of elements by which the
great lake of the Mississippi was drained of its waters, the aged
forests rearing themselves from its ancient bed, and the venerable
monuments resting upon the surface, satisfactorily demonstrate.
Remains, also, of a huge animal of graminivorous habits, but
differing from the mastodon, have, within a few years, been
disinterred from the soil. The theory of the Baron Cuvier, that our
earth is but the wreck of other worlds, meets with ample
confirmation in the geological character of the Western Valley.
As to agricultural productions, besides those of the more ordinary
species, the soil of the American Bottom, in its southern sections,
seems eminently 225 adapted to the cultivation of cotton, hemp, and
tobacco, not to mention the castor-bean and the Carolina potato.
The tobacco-plant, one of the most sensitively delicate members of
the vegetable family, has been cultivated with more than ordinary
success; and a quantity inspected at New-Orleans a few years since
was pronounced superior to any ever offered at that market.
As I journeyed leisurely onward over this celebrated tract, extensive
and beautiful farms spread out themselves around me, waving in all
the gorgeous garniture of early autumn. The prairie was carpeted
with the luxuriant richness of the golden rod, and all the gaudy
varieties of the heliotrope and asters, and the crimson-dyed leaves
of the dwarf-sumach; while here and there upon the extended plain
stood out in loneliness, like a landmark of centuries, one of those
mysterious tombs of a departed race of which I have already said so
much. Some of them were to be seen rearing up their summits from
the hearts of extensive maize-fields, crowned with an exuberance of
vegetation; and upon one of larger magnitude stood a white
farmhouse, visible in the distance for miles down the prairie. The
number of these ancient mounds upon the American Bottom is
estimated at three hundred; far more than are to be found upon any
other tract of equal extent.

At the old French village of Prairie du Pont,[78] situated upon a creek

of the same name, I made the necessary tarry for some
refreshment, upon which breakfast or dinner might have laid nearly
equal 226 claim to bestow a name. The most striking circumstance
which came under my observation during my delay at this place was
a very novel mode of producing the metamorphosis of cream into
butter pursued by these villagers; a manœuvre executed by beating
the cream with a spoon in a shallow basin. This operation I beheld
carried on by the dark-browed landlord, much to my ignorance and
wonder, with not an idea of its nature, until the substance produced
was placed upon the board before me, and called butter. Prairie du
Pont is one of the dampest, filthiest, most disagreeably ruinous of all
the old villages I have ever visited. A few miles to the north is
situated Cahokia,[79] one of the earliest settlements in the state, and
the ancient residence of the Caoquias, one of the tribes of the Illini
Indians. The place is supposed to have been settled by the followers
of La Salle during his second expedition to the West in 1683, on his
return from the mouth of the Mississippi. More than a century and a
half has since elapsed; and the river, which then washed the foot of
the village, is now more than a mile distant. This removal
commenced, we are told, shortly after the first settlement, and well
exemplifies the arbitrary character of the Western waters. Formerly,
also, a considerable creek, which yet retains the name of the village,
passed through its midst, discharging itself into the Mississippi not
far below. The outlet is now several miles higher up; and tradition
attributes the change to the pique of an irritated villager, who, out of
sheer spite to the old place and its inhabitants, 227 cut a channel
from the creek to the river, and turned the waters from their ancient
course.
As French immigration at Cahokia increased, the Indian tribe
receded, until the last remnant has long since disappeared. Yet it is a
singular fact in the history of this settlement, that, notwithstanding
the savages were forced to abandon a spot endeared to them by
protracted residence and the abundance of game in the
neighbouring prairies and lakes, they have ever regarded their
successors with feelings of unchanging friendliness. How different,
under the same circumstances, was the fate of the settlements of
Plymouth and Jamestown; and even here, no sooner did the
American race appear among the French, than hostilities
commenced.
For many years Cahokia, like old Kaskaskia, was the gathering-spot
of a nomadic race of trappers, hunters, miners, voyageurs, engagés,
couriers du bois, and adventurers, carrying on an extensive and
valuable fur-trade with the Indian tribes of the Upper Mississippi.
This traffic has long since been transferred to St. Louis, and the
village seems now remarkable for nothing but the venerableness of
age and decay. All the peculiarities of these old settlements,
however, are here to be seen in perfection. The broad-roofed,
whitewashed, and galleried cottage; the picketed enclosure; the
kitchen garden; the peculiar costumes, customs, poverty, ignorance,
and indolence of the race, are here met, precisely as has more than
once already been described in these volumes. Here, too, is the gray
old Catholic church, in which service is still regularly 228 performed
by the officiating priest. Connected with it is now a nunnery and a
seminary of education for young ladies. The villagers still retain their
ancient activity of heel and suppleness of elbow; and not a week is
suffered to pass without a merry-making and a dance. The old
"common field" is still under cultivation; and, uncurtailed of its fair
proportions, stretches away up the bottom to the village opposite St.
Louis. This valuable tract, held in common by the villagers of
Cahokia and Prairie du Pont, has been confirmed to them by act of
Congress; and, so long since as fifty years, four hundred acres
adjoining the former village were, by special act, granted to each
family.[80] The number of families is now, as has been the case this
century past, about fifty, neither diminishing nor increasing. Very few
of the inhabitants are of American origin, and these are liable to
annual attacks of fever, owing to the damp site of the place and the
noxious effluvia of the numerous marshes in the vicinity. Upon the
French villagers these causes of disease exert no effect, favourable
or unfavourable. A few acres of corn; a log cabin; a few swarthy
responsibilities, and a few cattle; a cracked fiddle, and a few
cartloads of prairie-grass-hay in autumn, seems the very ultimatum
of his heart to covet or his industry to obtain.
The road from Cahokia to the city, inasmuch as it is not often
conscious of a more dignified equipage than the rude market-cart of
the French villager, is of no wonderful celebrity for breadth, or
uniformity of track, or excellence of structure. It extends 229 along
the bank of the Mississippi, and is shaded on either side by the strip
of forest which skirts the margin. After a tarry of several hours at
Cahokia, and an excursion among the mounds of the neighbouring
prairie, near sunset I found myself approaching "Illinois-town,"
opposite St. Louis.[81] It was the calm, soft evening hour; and, as I
now advanced briskly over the prairie, the cool breeze was
whispering among the perfumed grass-tops, and "night's silvery veil"
was slowly gathering along the retreating landscape. The sun went
down like a monarch, robed in purple, and the fleecy clouds which
had formed his throne rolled themselves in rich luxuriance along the
horizon, suffused in the beautiful carmine of the heavens. At
intervals an opening in the forest laid bare the scene of splendour as
I hastened onward, and then all was dusk again. Winding among the
group of mounds reposing in the deepening twilight, and penetrating
the grove of pecans, the moon was just beginning to gild the gliding
wave at my feet as my horse stood out upon the bank of the stream.
Clear and distinct beyond, against the crimson back-ground of the
evening sky, were cut the towers, and cupolas, and lofty roofs of the
city; while in front, the lengthened line of white warehouses
gleamed from the shade along the curving shore: and the eye, as it
glanced up the far-retreating vistas of the streets, caught a glimpse
of deeper glories along the narrow zone of horizon beyond. The
broad sheet which I was now crossing seemed, with the oily gliding
of its ripples, completely died in the tender roseate of the 230 sunset
sky. As the shades of evening deepened into night, one after another
these delicate hues faded gently away: and the moonlight streamed
in full floods of misty magnificence far over the distant forests; the
evening-bells of the city pealed out merrily over the waters; the
many lights of the steamers cheerfully twinkled along the landing;
and, as the last faint glimmer of day had gone out, and night had
resumed her sable reign, I found myself once more amid the "crowd
and shock of men," threading the long, dusty streets of St. Louis....

Gentle Reader, the tale is told—our task is ended—

"And what is writ, is writ;

Would it were worthier!"
Our pilgrimage is over, fellow-wanderer. Full many a bright day have
we trod together the green prairies, and glided over the far-winding
waters of the fair Valley. Together have we paused and pondered
beside the mysterious mausoleum of a race departed. We have
lingered among the time-stained dwellings of an ancient and peculiar
people, and with kindling interest have dwelt upon the early
chronicles and the wild legends of the "far off," beautiful West. But
autumn is upon us—shadowy autumn, dark on the mountain-brow.
Her purple mistiness is deepening over the distant landscape; and
the chill rustle of her evening wind, in melancholy whisperings,
wanders among the pennoned 231 grass-tops. Our pilgrimage
ceases, yet with no unmingled emotions do I say to thee "pax
vobiscum!"

"Ye! who have traced the Pilgrim to the scene

Which is his last, if in your memories dwell
A thought which once was his, if on ye swell
A single recollection, not in vain
He wore his sandal-shoon and scallop-shell:
Farewell!"

St. Louis, Oct., 1837.

De Smet's Letters and Sketches, 1841-1842

Reprint of original English edition: Philadelphia, 1843
Allegorical Sketch
Facsimile of title-page, De Smet's Letters and Sketches
 PREFACE
To those who love their country, and their fellow men, we present
this interesting Narrative, with the hope, we might say, the certainty,
that its perusal will afford them some moments of the purest
gratification. We have seldom met any thing more entertaining. Its
simple, manly eloquence enchants the attention. The facts it makes
known to us of the "far, far West," the dispositions and habits of the
Indian Tribes who roam over the vast region of the Oregon, their
present state and future prospects, are such as cannot fail to
awaken lively interest in all who love to look around them beyond
the narrow horizon of every-day scenes, and learn what the holy
servants of God are doing for His sake and in His name in distant
parts of the world. We have conversed with the apostolic man from
whose pen we receive this narrative; and as we listened we felt at
once honoured and delighted to be so near one who in our days and
in his own person brings before us that lofty spirit of missionary
devotedness—those thrilling scenes of Indian life and adventure
which we so much admire in the pages of Charlevoix and Bancroft.
vi Truly our country is full of interest to those who watch its
progress, and compare it with the past. Who, for example, could
have dreamt that the Iroquois, the savage Mohawk,—under which
name we best know the tribe, and whose startling yell so often
made our forefathers tremble,—would have been chosen to kindle
the first faint sparks of civilization and Christianity among a large
portion of the Indian tribes beyond the Rocky Mountains? This is one
of the singular facts which these pages present to us. They abound
in others not less singular and interesting. Many of these Indian
nations actually thirst after the waters of life—sigh for the day when
the real "Long Gown" is to appear among them, and even send
messengers thousands of miles to hasten his coming. Such longing
after God's holy truth, while it shames our colder piety, should also
enflame every heart to pray fervently that laborers may be found for
this vast vineyard—and open every hand to aid the holy, self-devoted
men, who, leaving home and friends and country, have buried
themselves in these wilds with their beloved Indians, to live for them
and God. One of their favourite plans at this moment is to introduce
among them a taste for agriculture, with the means to pursue it.
They believe it to be the speediest, perhaps the only way by which
the Indians may be won from the wandering life they now vii in
general lead and from the idle habits it engenders. To aid them in
this philanthropic object is our sacred duty as men, as Americans, as
Christians. It is at least one method of atonement for the countless
wrongs which these unfortunate races have received from the
whites. We should be grateful to have such an opportunity of doing
good: let none suffer the occasion to pass unhonoured by some
tribute to the noble cause—some evidence of their love for God,
their country and their fellow man.
The frontispiece is from the pencil of one of the Indian Missionaries.
It blends the skill of the artist with the fancy of the poet, and will
hardly be understood without a word of explanation. In the
foreground we see several of the gigantic trees of the Oregon
forests, fallen and crossing each other. On these repose two wolves,
a squirrel and several serpents. Above, two Indian chiefs, surnamed
in baptism after the great Apostles of the Gentiles, Peter and Paul,
are supporting a large basket of hearts,—an offering to heaven from
the grateful wilderness. On the right are the emblems of Indian life
and warfare: the bow and arrows, battle-axe and shield. Below and
above these are seen some of the most remarkable animals of the
country—the bear, the viii wild horse, the badger, the graceful
antelope, intermingled with the plover, the pigeon, the wood-cock,
the bittern, and other birds of the region. On the left are the
peaceful symbols of Christianity—the Bible and the Cross, the chalice
and altar lights—the anchor, symbol of faith and hope—the trumpet,
to proclaim the word of God and bid the desert bless His holy name.
Here too we behold several of the noble animals of the territory—the
buffalo, the deer and elk, the mountain sheep and different birds. In
the distance are seen on the right, Indian mounds, and a water-
spout rising from the river Platte, and on the left, the Rocky
Mountains surmounted by the Cross. Festoons, composed of the
various flowers the Fathers have met on their way over mountains
and prairies and through lonely vallies, complete the picture—the
whole supported at the extremities by different birds of the country,
and in the centre by the American eagle,—fit emblem, we may say,
of their own dauntless faith, as well as of the heroic spirit of the
nation within whose borders they have their principal station, and
from whose genuine piety they have received the most consoling
assurances of final success, viz: the Flat Head Indians and the
Pends-d'oreilles, who are styled, even by their foes, the "nation of
chiefs."
ix Once more we earnestly commend the noble cause of these
devoted Missionaries to the charity of every sincere Christian. The
short time allowed to prepare the work for the press must be our
apology for several imperfections or errors which may meet the eye
of the reader.
 BOOK I
Dies venit, dies tua
In qua reflorent omnia,
Lætemur et nos in viam,
Tua reducti dex-tera.

The days of spring are drawing near

When all thy flowers will re-appear,
And we redeemed by thy right hand,
Shall walk in gladness thro' the land.
 LETTER I
St. Louis University, Feb. 4, 1841.
TO THE REV. F. J. B.
Rev. and Dear Sir:
I presume you are aware, that in the beginning of last Spring, I was
sent by the Right Rev. Bishop of St. Louis,[82] and my Provincial, on
an exploring expedition to the Rocky Mountains, in order to ascertain
the dispositions of the Indians, and the prospects of success we
might have if we were to establish a mission among them. It is truly
gratifying to me to have so favorable a report to make.—My
occupations do not allow me to enter into all the details; I shall
therefore be satisfied at present with giving you a brief sketch of my
journey and its result.
I started from Westport on the 30th of April, in company with the
Annual Expedition of the American Fur Company, which for this year
had appointed the rendezvous on Green River, a tributary of the Rio
Colorado of the West.[83] Captain Dripps, who commanded the
caravan, treated me on all occasions with the most polite attention.
[84] On the 6th day of our journey I was seized with the fever and
ague, and have been subject to it for nearly five months. Nothing
particularly worth noticing, occurred during the journey, except,
when we halted in the village of the Sheyennes.[85] I was introduced
to the Chiefs as a minister of the Great 14 Spirit: they showed me
great deference, and I was invited to a feast. I had to pass at first
through all the ceremonies of the calumet; the great chief
approached me to shake hands, and gave me a heartfelt "How do
you do."—"Blackgown," said he, "my heart was filled with joy when I
learned who you were. My lodge never received a visitor for whom I
feel a greater esteem. As soon as I was apprised of your coming, I
ordered my great kettle to be filled, and in your honor, I commanded
that my three fattest dogs should be served up." The bravest
warriors of the nation partook of the repast, and I availed myself of
the opportunity to explain to them the most important tenets of
Christianity. I told them the object of my visit, and enquired whether
they would not be satisfied to have also Black-gowns among them,
who would teach them to love and serve the Great Spirit, as he
wished. "Oh yes," they eagerly answered, "we will gladly provide for
every thing that they stand in need of; they will not die of hunger
amongst us." I have no doubt but a zealous missionary would do a
great deal of good among them. They are about two thousand in
number. Their language, it is said, is very difficult. On the 30th of
June we arrived at the rendezvous.[86] An escort of warriors had
been provided for me by the Flat-heads. Our meeting was that of
children who come to meet their parent, and in the effusion of their
heart, they bestowed upon me the fondest names with a simplicity
truly patriarchal. They told me of all the interesting particulars of
their nation, and of the wonderful preservation of sixty of their men,
in a battle against two hundred Black-feet, which lasted five whole
days, and in which they killed fifty of their enemies, without losing a
single man of their number. "The Great Spirit watched over them;"
they said, "he knew that we were to guide you to 15 our camp, and
he wanted to clear the road of all the obstacles that you might have
found on your way. We trust we will not be annoyed any more by
the Black-feet; they went off weeping like women." We thanked
heaven for the signal preservation, and implored its assistance for
the new and perilous journey we were on the point of undertaking.
The Indians of different nations and the trappers, had assembled at
the rendezvous in great numbers, for the sake of the trade. On
Sunday, the fifth of July, I had the consolation of celebrating the holy
sacrifice of Mass sub dio. The altar was placed on an elevation, and
surrounded with boughs and garlands of flowers; I addressed the
congregation in French and in English, and spoke also by an
interpreter to the Flat-head and Snake Indians. It was a spectacle
truly moving for the heart of a Missionary, to behold an assembly
composed of so many different nations, who all assisted at our holy
mysteries with great satisfaction.—The Canadians sung hymns in
French and Latin, and the Indians in their native tongue. It was truly
a Catholic worship.... This place has been called since that time, by
the French Canadians, la prairie de la Messe.
About thirty of the principal chiefs of the Snake Indians invited me to
a council.[87] I explained to them the Christian doctrine in a
compendious manner—they were all very attentive—they then
deliberated among themselves for about half an hour, and one of the
chiefs, addressing me in the name of the others, said: "Black-gown,
the words of thy mouth have found their way to our hearts; they
never will be forgotten. Our country is open for thee; come to teach
us what we have to do, to please the Great Spirit, and we will do
according to thy words." I advised them to select among themselves
a wise and prudent man, who, every morning and evening, should
assemble them to offer 16 to Almighty God their prayers and
supplications; that there the good chiefs should have an opportunity
of exhorting their warriors to behave as they ought. The meeting
was held the very same evening, and the great chief promulgated a
law, that for the future, the one who would be guilty of theft, or of
any other disorderly act, should receive a public castigation. On
Monday, 6th, we proceeded on our journey.[88] A dozen Canadians
wished to accompany me, to have an opportunity, as they said, to
practise their religion. Eight days afterwards we arrived safely in the
camp of the Flat-heads, and Ponderas, or Pends d'oreilles.[89]
 Worship in the Desert

Immediately the whole village was in commotion; men, women and

children, all came to meet me, and shake hands, and I was
conducted in triumph to the lodge of the great chief Tjolizhitzay, (the
Big face.) He has the appearance of an old patriarch. Surrounded by
the principal chiefs of the two tribes, and the most renowned
warriors, he thus addressed me: "This day Kaikolinzosten (the Great
Spirit) has accomplished our wishes, and our hearts are swelled with
joy. Our desire to be instructed was so great, that three times had
we deputed our people to the Great Black-gown[90] in St. Louis, to
obtain a father. Now, Father, speak, and we will comply with all you
will tell us. Show us the road we have to follow, to come to the place
where the Great Spirit resides." Then he resigned his authority to
me; but I replied that he mistook the object of my coming among
them; that I had no other object in view, but their spiritual welfare;
that with respect to temporal affairs, they should remain as they
were, till circumstances should allow them to settle in a permanent
spot.—Afterwards we deliberated on the hours proper for their 17
spiritual exercises and instructions. One of the chiefs brought me a
bell, with which I might give the signal.
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