Professional Documents
Culture Documents
Chapter 6 Caring for the Client with Disorders of Fluid and Electrolyte Balance and
Acid/Base Balance ..............................................................................85
Basic Knowledge of Fluid and Electrolyte Balance ....................................................... 86
Regulation of pH and Its Effect on Fluid and Electrolytes .......................................... 87
How the Body Regulates pH ................................................................................ 87
Metabolic Acidosis .......................................................................................................... 87
Causes of Metabolic Acidosis ................................................................................ 87
Symptoms of Metabolic Acidosis .......................................................................... 88
Care of the Client with Metabolic Acidosis ......................................................... 88
Respiratory Acidosis ........................................................................................................ 89
Causes of Respiratory Acidosis.............................................................................. 89
Symptoms of Respiratory Acidosis ........................................................................ 90
Caring for the Client with Respiratory Acidosis .................................................. 90
Metabolic Alkalosis ......................................................................................................... 91
Causes of Metabolic Alkalosis ............................................................................... 91
Symptoms of Metabolic Alkalosis ......................................................................... 91
Caring for the Client with Metabolic Alkalosis.................................................... 92
Respiratory Alkalosis ....................................................................................................... 92
Symptoms of Respiratory Alkalosis ....................................................................... 92
Care of the Client with Respiratory Alkalosis ...................................................... 93
Normal Electrolyte Values ............................................................................................. 93
Changes Associated with Aging...................................................................................... 94
Exam Prep Questions ..................................................................................................... 96
Answer Rationales ........................................................................................................... 98
Suggested Reading and Resources ................................................................................. 99
Bone Marrow Transplantation and Stem Cell Transplantation (SCT) ..................... 145
Types of Transplants ........................................................................................... 145
Nursing Care After Transplantation .................................................................. 146
Hodgkin’s Lymphoma .................................................................................................. 147
Diagnosis of Hodgkin’s Lymphoma ................................................................... 147
Prognosis of Hodgkin’s Lymphoma ................................................................... 148
Treatment of Hodgkin’s Lymphoma.................................................................. 148
Diagnostic Tests for Review......................................................................................... 148
Pharmacology for Review ............................................................................................. 149
Exam Prep Questions ................................................................................................... 151
Answer Rationales ......................................................................................................... 153
Suggested Reading and Resources ............................................................................... 154
Chapter 10 Caring for the Client with Disorders of the Gastrointestinal System ................ 155
Ulcers............................................................................................................................. 156
Types of Ulcers.................................................................................................... 156
Treatment of Ulcers ............................................................................................ 157
Inflammatory Bowel Disorders .................................................................................... 159
Crohn’s Disease (Regional Enteritis) .................................................................. 159
Ulcerative Colitis ................................................................................................. 160
Diverticulitis .................................................................................................................. 161
Diagnosis of Diverticulitis ................................................................................... 161
Treatment of Diverticulitis ................................................................................. 161
Gastroesophageal Reflux Disease (GERD) .................................................................. 162
Diseases Associated with the Liver............................................................................... 163
Hepatitis ............................................................................................................... 163
Cirrhosis ............................................................................................................... 168
Pancreatitis ........................................................................................................... 170
Cholecystitis/Cholelithiasis .......................................................................................... 172
Symptoms of Cholecystitis and Cholelithiasis.................................................... 172
Diagnosis of Cholecystitis/Cholethiasis.............................................................. 173
Treatment of Cholecystitis.................................................................................. 173
Treatment of Cholethiasis................................................................................... 173
Clostridium Difficile ..................................................................................................... 174
Food-Borne Illnesses .................................................................................................... 175
Diagnostic Tests for Review......................................................................................... 176
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NCLEX-PN Exam Cram, Fifth Edition
Chapter 11 Caring for the Client with Disorders of the Musculoskeletal System................ 183
Fractures ........................................................................................................................ 184
Treating Fractures ............................................................................................... 184
Compartment Syndrome ..................................................................................... 187
Osteomyelitis ....................................................................................................... 188
Osteoporosis .................................................................................................................. 189
Treatment of Osteoporosis ................................................................................. 190
Gout............................................................................................................................... 190
Treatment of the Client with Gout .................................................................... 191
Rheumatoid Arthritis .................................................................................................... 191
Treatment of Rheumatoid Arthritis.................................................................... 192
Musculoskeletal Surgical Procedures ........................................................................... 193
Fractured Hip and Hip Replacement ................................................................. 193
Total Knee Replacement ..................................................................................... 194
Amputations ......................................................................................................... 195
Assistive Devices for Ambulation ................................................................................. 196
Crutches ............................................................................................................... 197
Canes .................................................................................................................... 197
Walkers ................................................................................................................ 198
Diagnostic Tests for Review......................................................................................... 198
Pharmacology for Review ............................................................................................. 199
Exam Prep Questions ................................................................................................... 201
Answer Rationales ......................................................................................................... 203
Suggested Reading and Resources ............................................................................... 204
Chapter 12 Caring for the Client with Disorders of the Endocrine System ....................... 205
The Endocrine System ................................................................................................. 206
Pituitary Disorders ........................................................................................................ 206
Tumors of the Pituitary....................................................................................... 207
Thyroid Disorders ........................................................................................................ 209
Hypothyroidism ................................................................................................... 209
Hyperthyroidism .................................................................................................. 210
xi
Contents
Chapter 13 Caring for the Client with Disorders of the Cardiovascular System ................. 225
Hypertension ................................................................................................................. 226
Medications Used to Treat Hypertension .......................................................... 227
Heart Block ................................................................................................................... 227
Toxicity to Medications....................................................................................... 229
Malfunction of the Conduction System.............................................................. 229
Myocardial Infarction ................................................................................................... 230
Diagnosis of Myocardial Infarction .................................................................... 231
Management of Myocardial Infarction Clients .................................................. 232
Inflammatory Diseases of the Heart ............................................................................ 235
Infective Endocarditis .......................................................................................... 235
Pericarditis ........................................................................................................... 235
Buerger’s Disease .......................................................................................................... 236
Thrombophlebitis ......................................................................................................... 236
Raynaud’s Syndrome..................................................................................................... 237
Aneurysms ..................................................................................................................... 237
Congestive Heart Failure.............................................................................................. 238
Diagnostic Tests for Review ............................................................................... 238
Pharmacology Categories for Review .......................................................................... 239
Exam Prep Questions ................................................................................................... 240
Answer Rationales ......................................................................................................... 242
Suggested Reading and Resources ............................................................................... 243
xii
NCLEX-PN Exam Cram, Fifth Edition
Chapter 14 Caring for the Client with Disorders of the Neurological System .................... 245
Seizures .......................................................................................................................... 246
Types of Seizures ................................................................................................. 246
Treatment of Seizure Clients .............................................................................. 248
Status Epilepticus .......................................................................................................... 249
Brain Injuries ................................................................................................................. 249
Epidural Hematomas ........................................................................................... 250
Subdural Hematoma ............................................................................................ 250
Treatment of Epidural and Subdural Hematomas ............................................. 250
Increased Intracranial Pressure..................................................................................... 251
Treatment of ICP ................................................................................................ 253
Neurological Assessment .............................................................................................. 253
Cranial Nerve Assessment ................................................................................... 254
Glasgow Coma Scale ........................................................................................... 255
Intracranial Pressure Monitors............................................................................ 256
Care of the Client with Intracranial Surgery (Craniotomy) ....................................... 256
Cerebrovascular Accident/Stroke ................................................................................. 257
Spinal Cord Injury ........................................................................................................ 258
Treatment of Spinal Cord Injuries ..................................................................... 259
Potential Complications with SCI Clients ......................................................... 260
Guillain-Barré ............................................................................................................... 261
Treating Clients with Guillian-Barré ................................................................. 261
Degenerative Neurological Disorders.......................................................................... 261
Diagnostic Tests for Review......................................................................................... 263
Pharmacology for Review ............................................................................................. 263
Exam Prep Questions ................................................................................................... 265
Answer Rationales ......................................................................................................... 267
Suggested Reading and Resources ............................................................................... 268
Chapter 15 Caring for the Client with Psychiatric Disorders ........................................ 269
Anxiety Disorders.......................................................................................................... 270
Generalized Anxiety Disorder ............................................................................. 271
Panic Disorder ..................................................................................................... 271
Specific Phobia..................................................................................................... 271
Obsessive-Compulsive Disorder ......................................................................... 272
Trauma-Related Disorders ........................................................................................... 272
Posttraumatic Stress Disorder ............................................................................. 273
xiii
Contents
Wilda Rinehart Gardner received an Associate Degree in Nursing from Northeast Mississippi
Community College in Booneville, Mississippi. After working as a staff nurse and charge
nurse, she became a public health nurse and served in that capacity for a number of years. In
1975, she received her nurse practitioner certification in the area of obstetrics-gynecology
from the University of Mississippi Medical Center in Jackson, Mississippi. In 1979, she com-
pleted her Bachelor of Science degree in Nursing from Mississippi University for Women. In
1980, she completed her Master of Science degree in Nursing from the same university and
accepted a faculty position at Northeast Mississippi Community College, where she taught
medical-surgical nursing and maternal-newborn nursing. In 1982, she founded Rinehart and
Associates Nursing Consultants. For the past 26 years, she and her associates have worked
with nursing graduates and schools of nursing to assist graduates to pass the National Council
Licensure Exam for Nursing. She has also worked as a curriculum consultant with faculty to
improve test construction. Ms. Rinehart has served as a convention speaker throughout the
southeastern United States and as a reviewer of medical-surgical and obstetric texts. She has
co-authored materials used in seminars presented by Rinehart and Associates Nursing Review.
Dr. Diann Sloan received an Associate Degree in Nursing from Northeast Mississippi
Community College, a Bachelor of Science degree in Nursing from the University of
Mississippi, and a Master of Science degree in Nursing from Mississippi University for
Women. In addition to her nursing degrees, she holds a Master of Science in Counseling
Psychology from Georgia State University and a Doctor of Philosophy in Counselor
Education, with minors in both Psychology and Educational Psychology, from Mississippi
State University. She has completed additional graduate studies in healthcare administration
at Western New England College and the University of Mississippi. Dr. Sloan has taught
pediatric nursing, psychiatric mental health nursing, and medical-surgical nursing in both
associate degree and baccalaureate nursing programs. As a member of Rinehart and Associates
Nursing Review, Dr. Sloan has conducted test construction workshops for faculty and nurs-
ing review seminars for both registered and practical nurse graduates. She has co-authored
materials used in the item-writing workshops for nursing faculty and Rinehart and Associates
Nursing Review. She is a member of Sigma Theta Tau nursing honor society.
Clara Hurd received an Associate Degree in Nursing from Northeast Mississippi Community
College in Booneville, Mississippi (1975). Her experiences in nursing are clinically based,
having served as a staff nurse in medical-surgical nursing. She has worked as an oncology,
intensive care, orthopedic, neurological, and pediatric nurse. She received her Bachelor of
Science degree in Nursing from the University of North Alabama in Florence, Alabama,
and her Master of Science degree in Nursing from the Mississippi University for Women in
xix
About the Authors
Columbus, Mississippi. She currently serves as a nurse educator consultant and an independent
contractor. Ms. Hurd has taught in both associate degree and baccalaureate degree nursing
programs. She was a faculty member of Mississippi University for Women; Austin Peay State
University in Clarksville, Tennessee; Tennessee State University in Nashville, Tennessee; and
Northeast Mississippi Community College. Ms. Hurd joined Rinehart and Associates in 1993.
She has worked with students in preparing for the National Council Licensure Exam and with
faculty as a consultant in writing test items. Ms. Hurd has also been a presenter at nursing
conventions on various topics, including item-writing for nursing faculty. Her primary profes-
sional goal is to prepare the student and graduate for excellence in the delivery of healthcare.
Acknowledgments
Our special thanks to our editors, support staff, and nurse reviewers for helping us to organize
our thoughts and experiences into a text for students and practicing professionals. You made
the task before us challenging and enjoyable.
xx
NCLEX-PN Exam Cram, Fifth Edition
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Introduction
. D. Physiological integrity:
Even though the book is structured to the exam, these flagged items are often particularly
important:
. Exam Alert—Exam alerts normally stress concepts, terms, or activities that are related
to one or more test questions. Anything found in exam alert format is worthy of greater
attention on your part. This is what an exam alert looks like:
CAUTION
Exam alerts are provided as a heads up that the content mentioned here might appear on
the NCLEX-PN® exam.
xxiv
NCLEX-PN Exam Cram, Fifth Edition
NOTE
This is how notes are formatted. Notes direct your attention to important pieces of
information that relate to nursing and nursing certification.
. Tips—A tip might tell you another way of accomplishing something in a more efficient
or time-saving manner. An example of a tip is shown here:
TIP
This is how tips are formatted. Keep your eyes open for these, and you’ll learn some
interesting nursing tips!
. Exam Prep Questions—Although we talk about test questions and topics throughout the
book, the section at the end of each chapter presents a series of mock test questions and
explanations of both correct and incorrect answers.
. Practice Exams—This book offers two exams written in the NCLEX® format. These
have been provided to help you evaluate your readiness to test. Answers and rationale to
these questions have also been provided. We suggest that you score the exam by subtract-
ing the missed items from the total and dividing the total answered correctly by the total
number of questions. This will give you the percentage of correct answers. We suggest
that you achieve a score of at least 77% before you schedule your exam.
. The Companion Website—The companion website includes a testing engine with
many practice questions that you should use repeatedly to practice your test-taking skills
and measure your level of learning. New alternative format questions have been added to
reflect changes in the new test plan. You should be able to correctly answer more than
77% of the questions on the practice tests before trying the real exam. The companion
website also contains Appendix A, “Things You Forgot,” Appendix B, “Need to Know
More?” and Appendix C, “Calculations.”
. Cram Sheet—At the beginning of the book is a tear card we call the Cram Sheet. This is
a helpful tool that gives you distilled, compressed facts and is a great tool for last-minute
study and review.
xxv
Introduction
Self-Assessment
Before you take the exam, you might have some concerns, such as
. Am I required to answer all 265 questions to pass? No. If you run out of time,
the computer looks at the last portion of the exam and determines whether you are
consistently above or below the pass point.
. What score do I have to make to pass the NCLEX-RN® Exam? There is not a set
score. When you were in nursing school, you might have been required to score 75%
or 80% to pass and progress onto the next level. The licensure exam is not scored in
percentages. The computer is looking for consistency above or below the pass point.
When the candidate shows this consistency, the computer stops asking questions.
. How do they develop the test plan? Every three years a survey is sent out to
approximately 4,000 newly licensed nurses. These nurses are asked questions based on
the “Activity Statement” for nursing practice. Based on the results of the survey, the test
plan is set by the National Council and members of the Licensure Committee. These
members are appointed from representative states.
xxvi
NCLEX-PN Exam Cram, Fifth Edition
. What types of questions will I be asked? The questions are either multiple–choice
or alternative items. Alternative items can be identifying a picture, putting on ear phones
and identifying sounds such as breath sounds, identifying grafts, filling–in–the–blanks,
identifying–a–diagram, placing–in–sequence, or checking–all–that–apply. Some examples
of alternative items are:
. Figure the 8-hour intake and output.
. Identify the area where the mitral valve is heard the loudest.
. Place in sequence the tasks you would use in the skill of washing your hands.
. Check all that apply to the care of the client after a cardiac catheterization.
. Will I have a calculator for math problems? Yes, a drop-down calculator is provided.
. Will I have something to write on in the testing area? Yes, a dry erase board or paper
will be provided. Don’t worry about the test givers thinking that you are cheating. They
clean and secure the area after each candidate.
. What if I get sick and cannot take my exam? You have a period of time allowed during
which you can cancel your appointment and reschedule. If, however, you do not contact
the Pearson VUE group in that allotted time and do not attend to take the exam, you
forfeit your money and have to reapply.
. Can I carry a purse or bag into the testing center? No, there will be lockers for
your use in the testing center. (Also, dress warmly because the area is usually cool.) Any
suspicious behavior can cause you to forfeit the opportunity to complete your test so be
sure to leave any paper or notes in your car.
. Can I take breaks? Yes, there are optional breaks throughout the test.
. If I should fail, when could I retest? The required time to wait before you can rewrite
is 45 days in most states; however, some states require that you wait 90 days. Should you
be unsuccessful, you should contact the state where you want to obtain licensure for its
required retest time.
Companion Website
Register this book to get access to the Pearson Test Prep practice test software and other study
materials, plus additional bonus content. Check this site regularly for new and updated postings
written by the author that provide further insight into the more troublesome topics on the exam.
Be sure to check the box that you would like to hear from us to receive updates and exclusive
discounts on future editions of this product or related products.
xxvii
Introduction
NOTE
The cardboard case in the back of this book includes the paper that lists the activation code for the practice
exam associated with this book. Do not lose the activation code.
3. Enter your email/password for your account. If you don’t have an account on
PearsonITCertification.com or CiscoPress.com, you will need to establish one by going
to PearsonITCertification.com/join.
4. In the My Products tab, click the Activate New Product button.
5. Enter the access code printed on the insert card in the back of your book to activate your
product.
6. The product will now be listed in your My Products page. Click the Exams button to
launch the exam settings screen and start your exam.
7. Click Next and then the Finish button to download the exam data to your application.
8. You can now start using the practice exams by selecting the product and clicking the
Open Exam button to open the exam settings screen.
NOTE
The cardboard case in the back of this book includes a piece of paper. The paper lists the activation code for
the practice exam associated with this book. Do not lose the activation code. Also included on the paper is a
unique, one-time use coupon code for the purchase of the Premium Edition eBook and Practice Test.
No. If you run out of time, the computer looks at the last 60 items. If the candidate is
consistently above the pass point on the last 60 items, a passing report is registered.
. What score do I have to make to pass the NCLEX-PN® Exam?
There is not a set score. When you were in nursing school, you might have been required
to score 75% or 80% to pass and progress onto the next level. The licensure exam is not
scored in percentages. The computer looks for consistency above or below the pass point.
When the candidate shows this consistency, the computer stops asking questions.
. How do they develop the test plan?
Every 3 years a survey is sent out to approximately 4,000 newly licensed nurses. These
nurses are asked questions based on the Activity Statements for nursing practice. Based on
the results of the survey, the test plan is set by the National Council and members of the
Licensure Committee. These members are appointed from representative states.
. What types of questions will I be asked?
Yes, a magic slate or paper will be provided. Don’t worry about them thinking you are
cheating. They clean and secure the area after each candidate.
. What if I get sick and cannot take my exam?
You have a period of time allowed during which you can cancel your appointment and
reschedule. If, however, you do not contact your Pearson VUE testing center in that
allotted time and do not attend to take the exam, you forfeit your money and must reapply.
. Can I carry a purse or bag into the testing center?
No, there will be lockers for your use in the testing center. Also, be sure to dress warmly
because the area is usually cool.
. Can I take breaks?
The required time for rewriting the exam is 45 days in most states. If you are unsuccessful,
you should contact the state where you want to obtain licensure for its required retest time.
D. Physiological Integrity
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.