(eBook PDF) Study Guide for

Medical-Surgical Nursing: Concepts for

Interprofessional Collaborative Care 9th
Edition
Visit to download the full and correct content document:
https://ebooksecure.com/download/ebook-pdf-study-guide-for-medical-surgical-nursin
g-concepts-for-interprofessional-collaborative-care-9th-edition/
CONG PT FO IN , OF 10
COLL - BO - AT - E R-
•; .
 Overview o Pro essional Nursing
Concepts or Medical-Surgical Nursing
1. Which nursing action best exemplifies the
concept of patient-centered care?
a. Uses sterile technique to establish a
peripheral intravenous catheter
b. Assesses the patient's values and attitudes
about advanced directives
c. Checks the patient's vital signs and
compares them to baseline values
d. Administers breathing treatments accord-
ing to the scheduled time
2. For which circumstance would the nurse alert
the Rapid Response Team?
a. Patient is newly diagnosed with multiple
organ failure.
b. Patient has difficulty breathing and intense
chest pain.
c. Patient has severe pain and ordered medi-
cation is not available.
d. Patient is threatening to leave the hospital
against medical advice.
3. An older patient, who was treated for a hip
fracture, is being discharged from the hospital
and transferred to a long-term care facility.
What would be included in managing the
transition of this patient?
a. A list of the patient's valuables and prop-
erty that were at the hospital
b. Available balance of Medicare benefits
after hospital costs are covered
c. Family's preferences regarding advanced
directives and living will
d. Discharge care instructions related to the
hip fracture and surgical site
Copyright © 2018, Elsevier Inc. All rights reserved.
4. Which health care workers are likely to be
members of a Rapid Response Team? Select
all that apply.
a. Critical care nurse
b. Respiratory therapist
c. Phlebotomist
d. Social worker
e. Intensivist
£ Pastoral caregiver
5. What is the best way for the nurse to assess
the patient's understanding after teaching?
a. Have the patient teach important points
to the family.
b. Ask the patient to repeat back the infor-
mation.
c. Quiz the patient on relevant points of the
information.
d. Repeat the important points to the patient.
6. Which type of evidence would be rated high-
est on a level of evidence scale?
a. A nurse researcher studies a select number
of nutritional factors among childhood
cohorts who are matched for age.
b. A nurse researcher randomly selects chil-
dren from a walk-in clinic and describes
their daily dietary intake.
c. A nurse researcher studies selected
children with specific dietary needs and
instructs them about nutritious meals.
d. A nurse researcher conducts a meta-
analysis of all randomized controlled
dietary studies among children.
1
 2 CHAPTER 1 Overview of Professional Nursing Concepts for Medical-Surgical Nursing
7. Which occurrence would be considered a
sentinel event?
a. A 23-year-old postpartum woman is
admitted for abdominal pain and dies of
•
sepsis.
b. A 69-year-old man has a cardiac arrest in
the cafeteria and is admitted to intensive
care.
c. A 5-year-old is admitted for injuries and
the father admits to repeatedly beating the
child.
d. A 28-year-old man commits vehicular
homicide and is accompanied by police to
the hospital.
8. Which nursing action exemplifies the goal of
case management in an acute care setting?
a. Making sure the patient's dietary choices
meet prescribed nutritional needs
b. Coordinating inpatient and community-
based care before discharge
c. Monitoring the patient's vital signs and
noting trends of change over time
d. Reviewing the patient's hospital bill for
accuracy and any excessive charges
9. Which nursing actions possess a high risk for
contributing to error and patient harm? Select
all that apply.
a. Caring for several unstable patients who
require complex nursing and medical
interventions
b. Requesting the assistance of another staff
member to turn a patient
c. Administering cardiac medications before
evaluating vital signs
d. Preparing medications while trying to
answer a student's questions about labora-
tory results
e. Recognizing a patient's change in mental
status but assuming that it is transitory
f. Taking a verbal order over the phone from
a health care provider regarding a patient's
code status
Copyright © 2018, Elsevier Inc. All rights reserved.
10. Which situation is an example of a nursing
intervention that addresses the Institute of
Medicine/Quality and Safety Education for
Nurses (IOM/QSEN) health care disparities
competency?
a. Nurse recognizes that the patient's man-
nerisms are sexually offensive.
b. Nurse administers pain medication as
scheduled, before the patient requests it.
c. Nurse listens with sensitivity while the
lesbian patient talks about discrimination.
d. Nurse advises an abused woman about
legal protection, such as a restraining order.
11. According to ethical principles, which patient
has been provided social justice?
a. Patient with no health insurance receives
the same care as all other patients.
b. Patient gets a bath and a back rub at the
exact time that the nurse promised.
c. Patient decides what will be included in
the advanced directives.
d. Patient agrees with the nurse's advice to
eat a healthy and balanced diet.
12. When using the Situation, Background, As-
sessment, Recommendation (SBAR) method
of communication, the nurse would include
which information in the B section?
a. Recommend fingerstick glucose moni-
toring.
b. Patient states he feels dizzy and light-
headed.
c. Admission diagnosis is new-onset type
2 diabetes.
d. Blood pressure is 130/90 mm Hg; heart
rate is 89 beats per minute.
13. Which tasks should the nurse delegate to an
unlicensed assistive personnel (UAP)? Select
all that apply.
a. Turn patient every 2 hours.
b. Evaluate patient's skin during bathing.
c. Feed patient breakfast and lunch.
d. Assist patient with morning care.
e. Take and record patient's vital signs.
f. Discontinue IV infusion.
 CHAPTER 1 Overview of Professional Nursing Concepts for Medical-Surgical Nursing 3

14. Which occurrence does The Joint Commis-
sion's National Patient Safety Goals designate
as a high-risk issue?
a. Being exposed to infectious diseases in the
workplace
b. Violating privacy of patients' confidential
information
c. Administering medication that is not
familiar to the nurse
d. Failing to review patients' food allergies
before serving meals
15. Which patient is most likely to experience
inequality in health care?
a. A 73-year-old transgender female who
is asking for directions to the public
restroom
b. A 56-year-old woman who has liver failure
and wants to be on the transplant list
c. A 34-year-old man seeking treatment for a
broken wrist sustained by falling from a
motorcycle
d. A 17-year-old female who wants a
pregnancy test but is unaccompanied
by a parent

Copyright© 2018, Elsevier Inc. All rights reserved.

 or

1. The patient's recent history includes several 5. The nurse is providing care for a patient with
episodes of nausea and vomiting. Which adenocarcinoma of the lungs. Which medical-
medical-surgical concept is the nurse's highest surgical concept is the nurse's highest priority?
priority? a. Acid-base imbalance
a. Acid-base imbalance b. Gas exchange
b. Cellular regulation c. Cellular regulation
c. Gas exchange d. Immunity
d. Perfusion
6. The nurse plans to teach primary prevention
2. The patient has a pH of 7.49. Which is an to a patient to promote cellular regulation and
example of compensation for the imbalance of prevent impaired cellular regulation. Which
this concept? topics would the nurse include? Select all that
a. Kidneys reabsorb bicarbonate. apply.
b. Respiratory rate increases. a. Prevent skin cancer by minimizing expo-
c. Kidneys excrete H + ions. sure to sunlight.
d. Lungs decrease C02 excretion. b. Prevent colon cancer by eating a diet low
in fiber and saturated fats.
3. Which is an example of an intervention to c. Stop smoking to prevent oral or lung
cancer.
prevent acid-base imbalance?
a. Patient with type 2 diabetes avoids d. Get regular exercise to help prevent all
types of cancers.
carbohydrates.
b. Patient with COPD quits smoking. e. Be aware of family illness history and
screen for risk factors.
c. Patient with alkalosis uses daily antacids.
d. Patient with heart disease consumes £ Avoid exposure to environmental hazards
hamburgers daily for lunch. to prevent all types of cancers.

7. The nurse is caring for a patient who is a smoker

4. Which are risk factors for impaired cellular
with a history of polycythemia and immobility
regulation? Select all that apply.
issues. Which medical-surgical concept is the
a. Adult 45-50 years old
nurse's highest priority for this patient?
b. Poor nutrition
a. Gas exchange
c. Radiation therapy
b. Clotting
d. Excessive exercise
c. Fluid and electrolyte imbalance
e. Smoking cigarettes
d. Comfort
£ Exposure to pollution

4 Copyright© 2018, Elsevier Inc. All rights reserved.

 CHAPTER 2 Overview of Health Concepts for Medical-Surgical Nursing 5
-
8. Which condition is an example of an imbal- 13. Which nursing interventions are appropriate
ance concept that results in decreased clotting? when caring for a patient with late-stage
a. Atrial fibrillation dementia? Select all that apply.
b. Polycythemia a. Frequently reorient the patient.
c. Cirrhosis of the liver b. Provide a safe environment.
d. Venous thromboembolism c. Teach the patient what is real and what is
unreal.
9. The patient is admitted with a venous throm- d. Observe for delusions or hallucinations.
bosis in a deep vein of the leg. The chances e. Teach family that the patient should not
of which event does the nurse recognize are operate machinery.
increased as a physiologic consequence of f. Allow the patient to make his or her own
the impaired clotting? decisions.
a. Pulmonary embolus
b. Superficial phlebitis 14. The nurse is caring for a postoperative patient
c. Hemorrhagic stroke whose surgery occurred that morning. Which
d. Epistaxis cause is most likely responsible for the altera-
tion in the medical-surgical concept of comfort?
10. Which are signs and symptoms of impaired a. Stress
clotting? Select all that apply. b. Nausea
a. Purpural lesions c. Pain
b. Localized redness d. Anxiety
c. Ecchymosis
d. Prolonged bleeding 15. The nurse is assessing a patient for altered
e. Swelling and warmth bowel elimination related to constipation.
£ Hematuria Which finding would the nurse expect?
a. Overactive bowel sounds
11. Which statement by a patient indicates the b. Hypoactive bowel sounds
need for additional teaching about the risk for c. Distention of the bladder
increased clotting? d. Skin breakdown
a. ''I will cross my legs only when sitting
down:' 16. A patient has altered bowel elimination related
b. ''I will drink plenty of fluids so that I will to diarrhea. Which are appropriate nursing
stay hydrated:' care interventions for this patient? Select all
c. ''I will avoid sitting for long periods of that apply.
time:' a. Protect the perineal and buttock area with
d. ''I will notify my health care provider if a barrier cream.
I see redness or swelling in my leg:' b. Encourage the patient to consume foods
high in calcium such as cheese and
12. The nurse assesses a patient for impaired yogurt.
cognition and finds that the confusion is c. Check the patient's weight each day for
recent, with a rapid onset. Which type of weight loss.
impaired cognition does the nurse recognize d. Restrict fluid intake to help decrease
for this patient? episodes of diarrhea.
a. Delirium e. Keep the patient's skin clean and dry.
b. Amnesia f. Carefully document all intake and
c. Dementia output.
d. Fluctuating confusion

Copyright © 2018, Elsevier Inc. All rights reserved.

 6 CHAPTER 2 Overview of Health Concepts for Medical-Surgical Nursing
-
17. Which intervention should the nurse delegate
to the unlicensed assistive personnel (UAP)
when caring for a patient with altered bowel
elimination related to urinary incontinence?
a. Instruct the patient about use of protective
briefs.
b. Assess the patient's skin for redness or
breakdown.
c. Monitor the patient for symptoms of elec-
trolyte imbalance.
d. Assist the patient to the bathroom every
2 hours.
18. The nurse is assessing a patient with altered fluid
volume related to excess fluids. Which sign or
symptom would the nurse expect to find?
a. Weak, thready pulses
b. Increased blood pressure
c. Decreased heart rate
d. Decreased urine output
19. Which patient is most at risk for an alteration
in fluid and electrolyte balance?
a. 85-year-old with chronic kidney disease
b. 72-year-old with constipation
c. 63-year-old with small burn to right
forearm
d. 51-year-old with diet high in fruits and
vegetables
20. Which processes are essential for the medical-
surgical concept of normal gas exchange to
occur?
a. Osmosis and respiration
b. Diffusion and absorption
c. Ventilation and diffusion
d. Absorption and osmosis
21. Which statement about risk factors for
impaired gas exchange is accurate?
a. Only acute problems result in decreased
ventilation to cause impaired gas ex-
change.
b. Short-term immobility can lead to severely
impaired gas exchange.
c. Retention of excess carbon dioxide can
lead to a respiratory alkalosis.
d. With age, pulmonary alveoli lose some
elasticity, causing a decrease in gas
exchange.
Copyright© 2018, Elsevier Inc. All rights reserved.
22. The nurse is caring for a patient with impaired
gas exchange. Which interventions are appro-
priate in the care of this patient? Select all
that apply.
a. Instruct the patient to get vaccinations to
prevent influenza and pneumonia.
b. Elevate the patient's bed into the high
Fowler's position.
c. Remind the patient to wash hands thor-
oughly after using the commode.
d. Administer bronchodilators as ordered by
the health care provider.
e. Remind the patient to use incentive
spirometry every hour while awake.
f. Keep oxygen in place by nasal cannula at
all times.
23. Which statement about the medical-surgical
concept of immunity is accurate?
a. Natural active immunity occurs when an
antibody enters the body and the body
creates antigens to fight off the antibody.
b. Artificial active immunity occurs via a
vaccination or immunization.
c. Natural passive immunity occurs via a
specific transfusion, such as immunoglob-
ulins.
d. Artificial passive immunity occurs when
antibodies are passed from a mother to the
fetus through the placenta, colostrum, or
breast milk.
24. Which are common risk factors for impaired
immunity? Select all that apply.
a. Lack of some immunizations in adults
b. Prescription and use of corticosteroid
drugs
c. Substance abuse disorders in adults
d. Younger age in adults
e. From lower socioeconomic groups in
adults
f. Undergoing radiation therapy in adults
 CHAPTER 2 Overview of Health Concepts for Medical-Surgical Nursing 7

25. The nurse is caring for a patient with impaired 29. The nurse is caring for a patient with impaired
immunity related to a suppressed immune nutrition related to bulimia nervosa. Which
system. Which intervention can the nurse are appropriate interventions for the care of
delegate to the unlicensed assistive personnel this patient? Select all that apply.
(UAP)? a. Administer high-protein nutrient supple-
a. Teach the patient to avoid contact with ments.
large crowds. b. Assess for dry skin and dry or brittle hair.
b. Monitor white blood cell levels each time c. Encourage regular, strenuous exercise at
the patient has a CBC drawn. least twice a day.
c. Assess the patient for allergies to d. Stress the need for intake of high-fat foods
prescribed medications. for weight gain.
d. Remind the patient to wash hands e. Monitor serum albumin and prealbumin
carefully before each meal. levels.
f. Provide teaching about bariatric surgery.
26. Which patient is at highest risk for impaired
mobility? 30. The patient has impaired nutrition related to
a. Patient with unrepaired hip fracture lactose intolerance. Which complication will
b. Patient with mild heart failure the nurse teach this patient about?
c. Post-cardiac-catheterization patient on a. Generalized edema
bedrest b. Iron deficiency anemia
d. Patient with fractured right radius c. Osteoporosis
d. Constipation
27. Which are common physiologic complications
for a patient with impaired mobility? 31. Which is a modifiable risk factor for the
Select all that apply. medical-surgical concept of perfusion?
a. Pressure ulcers a. Age
b. Changes in sleep-wake cycle b. Obesity
c. Constipation c. Gender
d. Sensory deprivation d. Genetics
e. Muscle atrophy
f. Urinary calculi 32. Which are signs of impaired central perfusion?
Select all that apply.
28. The patient has impaired mobility. Which a. Dizziness
intervention should the nurse delegate to the b. Decreased hair distribution
unlicensed assistive personnel (UAP)? c. Pallor of extremities
a. Assess skin for redness or breakdown. d. Difficulty breathing
b. Turn and reposition the patient every e. Chest pain
2 hours. f. Cyanosis of extremities
c. Teach the patient and family about the
need for adequate nutrition. 33. The patient has impaired sensory perception
d. Instruct the patient on how and when to related to smell and taste. Which question
use incentive spirometry. would the nurse ask this patient?
a. "Have you ever had a stroke or brain
injury of any kind?"
b. "Did you listen to loud music when you
were young?"
c. "Do you have any dry mouth side effects
with your antidepressant drug?"
d. "How recently was the prescription on
your eyeglasses changed?"

Copyright© 2018, Elsevier Inc. All rights reserved.

 8 CHAPTER 2 Overview of Health Concepts for Medical-Surgical Nursing

34. Which drugs are ototoxic and can cause 38. Which is the most common form of impaired
impaired sensory perception related to tissue integrity?
hearing? Select all that apply. a. Pressure ulcers
a. Salicylates b. Burns
b. Diuretics c. Growths or lesions
c. Antihistamines d. Injury or trauma
d. Antiepileptic drugs
e. Aminoglycosides 39. The nurse assesses a patient with impaired
f. Chemotherapy drugs tissue integrity. The patient has a wound that
extends through the epidermis and dermis.
35. Which is an example of a secondary interven- Which term best describes this wound?
tion to promote sensory perception? a. Full thickness
a. Using protective earplugs b. Partial thickness
b. Wearing safety goggles c. Pressure ulcer
c. Avoiding hypertension by taking antihy- d. Cellulitis
pertensive drugs
d. Having regular eye examinations 40. The nurse is caring for a patient who is at risk
for impaired tissue integrity. Which interven-
36. Which statement about the concept of sexuality tions will promote tissue integrity and prevent
is most accurate? impaired tissue integrity? Select all that apply.
a. Sexuality and reproduction are the same. a. Keep the patient's skin clean and dry.
b. The major goal of sexuality is the b. Provide a healthy diet including protein.
conception of a child. c. Give the patient protein shakes after each
c. Intimacy, self-concept, and role relation- meal.
ships are related to sexuality. d. Assist the patient to reposition in bed
d. The concept of sexuality is perceived in every 4 hours.
the same manner by most people. e. Place a gel pad on the chair before getting
the patient out of bed.
37. Which patient is most at risk for impaired f. Moisturize skin when needed to prevent
sexuality? excessively dry skin.
a. A 20-year-old female with a history of an
abortion
b. A 45-year-old male with erectile
dysfunction
c. A 65-year-old male with history of
prostate disease
d. A 85-year-old female who has been a
widow for 10 years

Copyright © 2018, Elsevier Inc. All rights reserved.

 Common Health Problems of
Older Adults
1. The home health nurse is reviewing the charts
of newly assigned patients. Which patient is
most likely to need an assessment for geriatric
failure to thrive?
a. A 66-year-old with heart failure, chronic
renal failure, and signs of liver failure
b. An 89-year-old who has a pacemaker and
must use a walker and a hearing aid
c. A 73-year-old who has osteoporosis,
history of fractures, and significant fallo-
phobia
d. A 69-year-old with depression, weight
loss, and impaired physical functioning
2. The nurse is caring for an older adult patient.
What are the best interventions to help reduce
relocation stress in this patient? Select all that
apply.
a. Explain all procedures to the patient
before they occur.
b. Reorient the patient frequently to
location.
c. Initially, encourage family and friends to
keep their visits to a minimum.
d. Provide opportunity and time for the
patient to participate in decision making.
e. Arrange for familiar keepsakes to be at the
patient's bedside.
f. Change room assignment several times
and assess for preferred choice.
Copyright© 2018, Elsevier Inc. All rights reserved.
3. Which older adult is demonstrating a health-
enhancing behavior that the nurse should
reinforce?
a. A 70-year-old farmer wears sunscreen
whenever sun exposure exceeds 6 hours
per day.
b. A 66-year-old man with a family history
of heart problems takes an aspirin twice
a day.
c. A 65-year-old nurse exercises regularly
three to five times a week.
d. An 88-year-old woman eats one serving
of vegetables four times a week.
4. The older patient tells the nurse that his teeth
are in poor condition, so he tends to eat soft
foods such as mashed potatoes, macaroni with
cheese, and ice cream. Which question is the
nurse most likely to ask to identify a probable
physiologic consequence of the patient's
dietary patterns?
a. "Do you have any problems with your
bowel movements?"
b. '~e you experiencing weight loss?"
c. "Have you had any changes in your
ability to accomplish ADLs?"
d. "Would you like me to help you make an
appointment with the dentist?"
9
 10 CHAPTER 3 Common Health Problems of Older Adults
5. The older patient is homebound, so the nurse
will focus on helping the patient to maintain
functional fitness. Which exercise is the nurse
most likely to suggest?
a. During the winter months, go to the mall
and walk around.
b. Attend an exercise class at a senior citizens'
center.
c. Walk on a treadmill 3-5 times per week
for 60 minutes.
d. Maintain independent performance of
ADLs.
6. Which older adult has the greatest risk for falls?
a. A 73-year-old who takes frequent walking
•
excursions
b. An 81-year-old who frequently calls for
help to change position
c. A 68-year-old who uses a cane when
ambulating
d. A 90-year-old who has decreased sensa-
tion in the lower extremities
7. The nurse is caring for a confused older
patient who is at risk for falls. Which interven-
tions should the nurse implement to ensure
the patient's safety? Select all that apply.
a. Remind the patient to use ambulatory
devices as needed.
b. Instruct the patient to limit activity as
much as possible.
c. Provide appropriate lighting in the
. ) .
patients envrronment.
d. Make sure the patient's eyeglasses are
clean and functional.
e. Implement facility-specific fall protocols.
f. Position the bed against the wall so the
patient can get out of bed on only one
side.
8. The patient requires physical restraints. Which
intervention should the nurse perform for this
patient?
a. Check the patient every 30-60 minutes.
b. Release the restraints at least every 4 hours.
c. Turn up the television volume to provide
distraction.
d. Minimize communication with the patient.
Copyright © 2018, Elsevier Inc. All rights reserved.
9. The charge nurse is reviewing all the medica-
tion administration records for the long-term
care facility. For older patients, which medica-
tion is the nurse most likely to question?
a. Tricyclic antidepressant
b. Antipsychotic
c. Antianxiety agent
d. Sedative-hypnotic
10. According to the Beers Criteria, the nurse
would question an order for which medication
in an older adult?
a. Promethazine
b. Thiothixen
c. Risperidone
d. Haloperidol
11. The creatinine clearance test result for an older
female patient is 70 mL/min. How would the
nurse handle the findings of this diagnostic
test?
a. Consult the pharmacy to determine if the
patient's drugs are harmful to the liver.
b. Notify the health care provider because
serum drug levels could become toxic.
c. Notify the health care provider because
drug doses will need to be increased.
d. Document the level in the patient's record
as within the normal range.
12. Which intervention would the nurse use if the
older adult is suffering from delirium?
a. Talk to the patient using a calm voice.
b. Prohibit visitors until the delirium abates.
c. Remove and safely store personal items.
d. Apply restraints to keep the patient safe.
13. The older patient reports early morning
insomnia, excessive daytime sleeping, poor
appetite, a lack of energy, and an unwilling-
ness to participate in social and recreational
activities. Which screening tool is the nurse
most likely to use first?
a. Confusion Assessment Method (CAM)
b. Geriatric Depression Scale-Short Form
(GDS-SF)
c. CAGE questionnaire
d. Brief Abuse Screen for the Elderly
 CHAPTER 3
14. In planning care for the older adult with de-
mentia, the nurse identifies which intervention
as the first priority goal of care?
a. Prevent cognitive decline.
b. Reorient on a regular basis.
c. Prevent injury.
d. Assist with ambulation.
15. The unlicensed assistive personnel (UAP) tells
the nurse that an older gentleman was wearing
a bra and women's panties when he was first
admitted to the unit. What instructions would
the nurse give to the UAP?
a. "Show me the bra and panties, and then I
will confront the patient:'
b. "Store the bra and panties away, and I'll
talk to the family later on:'
c. "Pretend like you never saw the lingerie,
and treat the patient like a male:'
d. "Assist the patient to dress, and allow him
to select his own clothing:'
16. On assessment of a newly admitted older
patient, the nurse notes cigarette burns on the
lower abdomen. Which term best describes
this finding?
a. Neglect
b. Physical abuse
c. Psychological abuse
d. Mistreatment
17. The patient is both confused and agitated.
Which action is most important at this time?
a. Place the patient in a quiet, supervised
area.
b. Check the patient every 2 hours.
c. Sedate the patient using IV medication.
d. Apply soft wrist restraints for a limited
time.
Copyright© 2018, Elsevier Inc. All rights reserved.
Common Health Problems of Older Adults 11
18. Which task should the nurse delegate to unli-
censed assistive personnel when caring for an
older adult?
a. Instruct the patient to drink at least
2 liters of fluids each day.
b. Assess the patient's skin every 2 hours
during repositioning.
c. Assist the patient with tray preparation
and feeding at mealtimes.
d. Teach the patient how to balance the diet
with healthy food selections.
19. The nurse is using the Fulmer SPICES frame-
work to assess an older adult. Which question
would the nurse ask when using SPICES?
a. Do you use a hearing aid?
b. How do you like to be addressed?
c. Have ever been treated for mental illness?
d. Have you had any recent falls?
20. An older resident living in a long-term care
facility is usually mildly confused, talkative,
outgoing, and cheerful but today is suddenly
quiet, apathetic, lethargic, unaware, and with-
drawn. What action would the nurse take
first?
a. Call the health care provider and report
the sudden change in behavior.
b. Take a full set of vital signs and check
pulse oximeter and glucometer readings.
c. Draw blood specimen and have it checked
for electrolyte and fluid imbalances.
d. Verbally and physically stimulate the resi-
dent until behavior returns to normal.
 Assessment and Care of
Patients with Pain
1. The nurse is working at a walk-in clinic and
has interviewed several patients. Which
patient has the most common reason for
seeking medical care?
a. Has a family history of angina
b. Has a personal history of chronic pain
c. Has drug addiction and is seeking pain
medication
d. Has a desire to avoid pain or injury
during exercise
2. The nurse is performing a pain assessment on
a patient who had abdominal surgery. He was
just transferred from the intensive care unit to
the medical surgical unit. Which question
would the nurse ask?
a. "You are probably having pain at the
incision site. Right?,,
b. "How bad is your pain? Is it better
compared to before?,,
c. "Can you tell me about any pain or
discomfort you are having?,,
d. "Do you think you can walk, or would you
like pain medication first?,,
3. The patient reports that he has chronic lower
back pain that is not relieved by the prescribed
medication and that the primary care provider
is unwilling to prescribe anything stronger.
Who should the nurse consult first?
a. Pharmacist
b. Physical therapist
c. Pain resource nurse
d. Alternate health care provider
12 Copyright © 2018, Elsevier Inc. All rights reserved.
4. Which patient has the highest risk for inade-
quate pain management?
a. 56-year-old man who had major abdomi-
nal surgery for a stab wound
b. 78-year-old woman who was transferred
to a nursing home after hip surgery
c. 10-year-old child who had a tonsillectomy
and whose parents can't speak English
d. 24-year-old postpartum woman with a
history of drug abuse
5. Which patient has chronic noncancer pain?
a. A 17-year-old male after an appendectomy
b. A 64-year-old male with back pain
related to tumor growth
c. A 48-year-old female who has persistent
pain related to interstitial cystitis
d. A 5-year-old female with stomach cramps
related to food poisoning
6. A patient with chronic leg pain reports pain
level at 7I 10, so the nurse administers a prn
medication. Which observation best suggests
that the functional goal of therapy is being met?
a. Patient appears relaxed while talking with
family members.
b. Pulse, blood pressure, and respirations are
not elevated.
c. Patient ambulates independently down the
hall without distress.
d. Patient asks for additional food between
lunch and dinner.
 CHAPTER 4
7. Despite the nurse's best efforts, the patient's
wife continuously asks the nurse to reassess
her husband's pain and to give him additional
medication. What is the best rationale for
using the concept of "self-report"?
a. The wife's behavior indicates that she is
overly anxious.
b. The concerns of the wife make accurate
pain assessment very difficult.
c. The patient's relationship with his wife is
interfering with the plan of care.
d. The patient is the only one who can
describe his experience of pain.
8. Which patient is most likely to report pain
that would be considered acute?
a. Has a history of peripheral vascular
disease; foot is suddenly cold and blue
b. Has a history of diabetic neuropathy;
reports burning sensation in lower leg
c. Has a history of old ankle fracture;
reports recent diagnosis of osteoarthritis
d. Has a history of osteosarcoma in the
femur with amputation above tumor site
9. In assessing pain in an older adult patient,
what is a major barrier to accurate assessment?
a. Many older adults are reluctant to report
•
pam.
b. Pain sensation decreases with age.
c. Pain scales are inaccurate for older adults.
d. Most older adults have some cognitive im-
pairment.
10. The nurse is caring for a patient on the first
postoperative day. The patient denies pain, but
his blood pressure and pulse are elevated and
he is diaphoretic and anxious. What should
the nurse do first?
a. Believe and document the patient's self-
report of "denies pain:'
b. Call the health care provider and report
the vital signs, diaphoresis, and anxiety.
c. Assess the patient for postoperative com-
plications or barriers to reporting pain.
d. Ask a family member if the patient would
typically be stoic during pain or discom-
fort.
Copyright© 2018, Elsevier Inc. All rights reserved.
Assessment and Care of Patients with Pain 13
11. The older patient tells the home health nurse
that he took two tablets of arthritis-strength
extended release acetaminophen at 6:00 am
and two tablets of hydro co done at 2:00 pm
and that he plans to take one dose of an over-
the-counter product that contains acetamino-
phen, doxylamine succinate, and dextro-
methorphan to sleep at night. What would the
nurse do first?
a. Call poison control, because the patient
has exceeded the recommended dose of
acetaminophen.
b. Tell the patient to call the health care pro-
vider and report all medications that he
takes.
c. Educate the patient about the acetamino-
phen in each product and the maximum
dosage/day.
d. Record the medications, frequency, and
dosage in the medication reconciliation
record.
12. The nurse knows that acute pain serves a
biologic purpose. How does the nurse apply
this knowledge in caring for a patient with a
history of cardiac problems who now reports
severe chest pain?
a. Immediately administers supplemental
oxygen
b. Calmly reassures that acute pain is usually
temporary
c. Efficiently assesses for anxiety or panic
attack
d. Quickly obtains an order for prn pain
medication
13. A patient with rheumatoid arthritis reports
having chronic pain for years with an exacerba-
tion that started in the morning. Which obser-
vation indicates the patient has a physiologic
adaptation to pain?
a. Pupils are dilated.
b. Breathing is shallow.
c. Pulse rate is 70/min.
d. Temperature is 98.6°F (37°C).
 14 CHAPTER 4 Assessment and Care of Patients with Pain
14. The nurse is caring for several patients who
will receive pain medication. Which patient is
most likely to receive around-the-clock oral
opioids?
a. Patient with fibromyalgia
b. Patient with chronic cancer pain
c. Patient with Crohn's disease
d. Patient who had a stroke
15. Which patient is most likely to receive a
prescription for gabapentin?
a. A patient who has persistent burning and
tingling sensation in the lower extremities
b. A patient who reports a gnawing and
burning discomfort in the epigastric area
between meals
c. A patient who expresses fear, anxiety, and
uncertainty related to episodes of angina
d. A patient who has intractable pain
related to malignant spread of cancer
16. Nociception involves the normal function of
physiologic systems and four processes. When
the nurse suggests listening to music as a
distraction, which process is the target of the
intervention?
a. Transduction
b. Transmission
c. Perception
d. Modulation
17. Which patient is having pain that is unlikely
to respond to first-line opioid and nonopioid
medication?
a. 62-year-old woman who fractured her
wrist
b. 70-year-old woman with postherpetic
neuralgia
c. SO-year-old man with a recently inserted
chest tube
d. 45-year-old man who sustained burns to
the hands
Copyright © 2018, Elsevier Inc. All rights reserved.
18. Which behavior exemplifies the nurse's
primary role in assessing and managing the
patient's pain?
a. Administers pain medication as ordered if
pain is sufficient to warrant therapy
b. Listens to the patient's self-report and
forms an opinion about the veracity of the
description
c. Observes for concurrent verbal reports
and nonverbal signs to substantiate pres-
ence of pain
d. Listens to and accepts the self-report of
pain and assesses patient's preferences and
values
19. What are physiologic responses that indicate a
patient is experiencing acute pain? Select all
that apply.
a. Diaphoresis
b. Somnolence
c. Bradypnea
d. Hypotension
e. Tachycardia
f. Dilated pupils
20. What is the best type of pain scale to use
for children or for adult patients who have
language barriers or reading problems?
a. 0 to 10 numeric rating scale
b. FACES (smile to frown)
c. Vertical presentation scale
d. Pasero Opioid-Induced Sedation Scale
21. The nurse asks the patient with cancer,
"Sir, where is your pain?" The patient repeat-
edly responds, "It hurts all over:' What is the
best rationale for taking the extra time to help
the patient to identify specific areas that hurt?
a. Documentation is incomplete as a legal
document if the nurse charts "hurts all
over:'
b. Formulating an achievable therapeutic
goal is very difficult for a vague complaint.
c. Health care provider cannot prescribe ap-
propriate medication for relief of general-
ized pain.
d. Patient understands the origin, and new
or increasing pain raises the suspicion of
metastasis.
 CHAPTER 4
22. Using the concept of comfort, which applica-
tion creates the greatest concern related to the
use of the patient-controlled analgesia (PCA)
infusion device?
a. Pendant
b. Demand
c. Lockout
d. Proxy
23. The nurse is assessing an elderly patient who
has "pain all over:' Which strategy would the
nurse use to help the patient identify which
areas of the body are painful?
a. Start with gentle palpation on the abdomen
and chest.
b. Focus on the hand and fingers of one
extremity.
c. Direct the patient to find one area that
does not hurt.
d. Provide examples and comparisons of
•
severe pam.
24. The home health nurse is reviewing the older
adult's medication and sees that naproxen is
prescribed. Which question is the nurse most
likely to ask in order to assess for adverse
effects?
a. "Have you noticed unusual fatigue, rest-
lessness, or feelings of depression?"
b. "Do you notice dry mouth, dizziness,
mental clouding, or weight gain?"
c. '~re you experiencing constipation,
itching, or excessive sleepiness?"
d. "Have you had any gastric discomfort,
vomiting, bleeding, or bruising?"
25. The nursing student is using the Wong-Baker
FACES pain rating scale to assess the pain of a
4-year-old child. The nurse would intervene if
the student performed which action?
a. Points to the smiling face and tells the
child that this face has "no pain"
b. Tells the child that FACES helps nurses
understand how he is feeling
c. Points to the tearful face and tells the child
that the picture means "worst pain"
d. Observes the child's facial expression and
matches it to a face on the scale
Copyright© 2018, Elsevier Inc. All rights reserved.
Assessment and Care of Patients with Pain 15
26. The nurse is assessing the patient for chronic
pain or discomfort. Which is the best question
to use to elicit the quality of the pain?
a. '~m I correct in assuming that you are
having pain?"
b. "Would you describe the pain as sharp?"
c. "Is the pain really bad right now?"
d. "How would you describe your pain?"
27. Based on evidence-based practice, what is the
best choice for managing chronic pain for a
73-year-old female with osteoarthritis?
a. Acetaminophen is the primary drug of
choice.
b. Tramadol is the first-line choice for this
patient.
c. Long-term use of an oral NSAID, such as
ibuprofen, is the best.
d. Topical NSAIDs and nonpharmacologic
measures should be tried first.
28. The nurse is assisting a surgical patient with
pain management. Which outcome statement
best demonstrates that the short-term goal is
being met 45 minutes after receiving pain
medication?
a. Patient reports that the pain level is 6/10.
b. Patient tolerates the dressing change with-
out grimacing.
c. Patient declines a prn anxiolytic
medication.
d. Patient asks for assistance to go to the
bathroom.
29. The patient reports a vivid childhood memory
of having severe pain during and after a dental
procedure and expresses reluctance to visit the
dentist even for routine cleanings. What
should the nurse do?
a. Refer the patient for psychological coun-
seling before seeking dental care.
b. Obtain an order for antianxiety medica-
tion and suggest relaxation techniques.
c. Suggest talking to a dentist about current
pain management techniques.
d. Advise patient that past fears should not
interfere with good health practices.
 16 CHAPTER 4 Assessment and Care of Patients with Pain
30. The nurse is interviewing a patient who fre-
quently comes to the clinic to obtain medica-
tion for chronic back pain. The patient states,
"I know you guys think I am faking, but I hurt
and I am really sick of your attitude:' What is
the best response?
a. "Sir, tell me about your pain and how it is
affecting your life:'
b. "Sir, you can speak to a pain specialist if
you would prefer:'
c. "Sir, I see you are frustrated, but you are
unfairly judging me:'
d. "Sir, we are trying our best; let's just
continue the interview:'
31. Which nursing action indicates that the nurse
is performing the first step of the Hierarchy of
Pain Measures?
a. Premedicates before a dressing change
b. Uses a standard pain assessment tool
c. Compares vital signs before and after pain
medication
d. Starts with a low dose and observes for
behavioral changes
32. A patient needs morphine 2 mg IV push. The
drug is available as 5 mg/mL. How many mL
would the nurse administer? mL of
morphine.
33. The nurse is assessing a patient with severe de-
mentia who resides in a long-term care facility.
A score of 9 is obtained using the Pain Assess-
ment in Advanced Dementia Scale. Based on
assessment findings, which action will the
nurse take?
a. Speak calmly to the patient and explain
that repositioning will make him more
comfortable.
b. Gently reassure the patient and continue
routine observation for discomfort or
• d. "Combining different analgesics gives
pam.
c. Assess the patient for the source of the
pain and immediately inform the health
care provider.
d. Contact the family and ask how the
patient would typically respond to
discomfort.
Copyright © 2018, Elsevier Inc. All rights reserved.
34. The home health nurse is visiting a 73-year-
old diabetic patient who was recently dis-
charged after surgery. While reviewing a list
of the patient's medications, the nurse sees that
there are several different classes of analgesics
listed. Which action is the nurse most likely
to take?
a. Assesses patient's understanding of the
multimodal treatment plan and ability to
comply
b. Contacts the health care provider to
discontinue medications that contribute
to polypharmacy
c. Emphasizes that medications with more
side effects are the last choice for pain
d. Advises the patient not to take any
NSAIDs because of irritation of gastric
mucosa
35. Which drug can cause adverse effects, particu-
larly in an older adult, because of an accumu-
lation of toxic metabolites?
a. Ibuprofen
b. Morphine
c. Meperidine
d. Acetaminophen
36. The nurse is giving discharge instructions
about multimodal analgesia to a daughter who
will care for her elderly father at home while
he recovers from surgery. The daughter sug-
gests that the single best medication should be
recommended for convenience and to save
money. What is the best response?
a. "The doctor always prescribes this combi-
nation of medications as the best therapy:'
b. "Elderly people frequently do better with
fewer medications; let me call the doctor:'
c. "Just see how it goes for your dad. It is
likely that you can gradually decrease the
medication:'
greater relief with lower doses and fewer
side effects:'
 CHAPTER 4
37. The patient has a severe burn on the hand and
forearm and reports pain that is severe and
escalating. The nurse anticipates that pain
medication will be administered via which
route?
a. Oral
b. Intravenous
c. Intranasal
d. Subcutaneous
38. The postanesthesia care unit reports to the
nurse in the medical-surgical unit that the
patient received 2 mg of intravenous mor-
phine with relief. When is the patient likely to
be transitioned to oral analgesics?
a. Upon arrival to the medical-surgical unit
b. When the health care provider writes
postoperative orders
c. When the patient is able to tolerate oral
intake
d. When the intravenous access is discontin-
ued
39. A patient is prescribed morphine sulfate.
Which nursing interventions decrease the risk
of constipation? Select all that apply.
a. Give foods that are soft, such as white
bread or white rice.
b. Encourage an increase in water and fluid
intake.
c. Administer a stool softener every morning.
d. Obtain an order for a bulk laxative.
e. Encourage movement, activity, and
walking.
f. Teach to keep a record of bowel move-
ments
40. A new, inexperienced nurse sees that the pa-
tient is receiving around-the-clock medication
but also has orders for prn analgesic every
4-6 hours as needed. How will the new nurse
determine when a prn dose is given?
a. Administer a dose every 6 hours to
ensure adequate relief.
b. Call the health care provider and ask for
specific parameters for prn dosing.
c. Look at the medication administration
record to see what the previous nurse gave.
d. Assess the patient for breakthrough pain
and anticipate painful procedures.
Copyright© 2018, Elsevier Inc. All rights reserved.
Assessment and Care of Patients with Pain 17
41. The health care provider informs the nurse
that a young patient should receive morphine
for severe pain but that caution is needed
because the patient is opioid nruve. Which
consideration is the most important in caring
for and observing this patient?
a. Decreased analgesia may occur because
the patient is opioid nruve.
b. Respiratory depression is a problem
only for elderly adults with respiratory
disorders.
c. Excessive sedation can progress to clini-
cally significant respiratory depression.
d. A standing order for a prn one-time dose
of naloxone is needed for adverse effects.
42. Which patient is least likely to be a good can-
didate for patient-controlled analgesia?
a. 32-year-old male with severe burns and a
history of drug abuse
b. 16-year-old male with multiple injuries
sustained during an accident
c. 34-year-old female with functional blind-
ness who had abdominal surgery
d. 25-year-old female with intermittent
lucidity after a severe head injury
43. The nurse is assessing a patient who is receiving
opioid medication via a patient-controlled anal-
gesia device. The patient is very drowsy and dif-
ficult to arouse. What should the nurse do first?
a. Wake the patient and tell the patient to
stop pushing the button so frequently.
b. Stay with the patient and discontinue the
basal rate.
c. Let the patient sleep but increase the
frequency of assessment.
d. Obtain an order for exclusive use of
nonopioid medication.
44. Based on the concept of comfort, what is the
expected physiologic consequence of taking a
mu opioid agonist?
a. An increase in dosage yields an increase in
pain relief.
b. There is a dose ceiling effect, so comfort is
readily achieved.
c. Analgesia is reversed at the peak effect.
d. Peak comfort is typically 15-20 minutes
after administration.
 18 CHAPTER 4 Assessment and Care of Patients with Pain
45. The nurse is caring for a patient who has an
epidural catheter for pain management. Which
information is appropriate in the care of this
patient?
a. Pain assessments are performed less
frequently if epidural catheters are used
for pain management.
b. Morphine and hydromorphone may
be used with a local anesthetic such as
bupivacaine.
c. Epidural catheters are used exclusively to
deliver single bolus doses during surgical
procedures.
d. The patient will be confined to bed during
the therapy because of lower extremity
weakness.
46. The patient has a history of rheumatoid arthri-
tis and is also being treated for acute pain
from a wrist fracture. Which medication is
most likely to be prescribed to reduce the
pain and discomfort caused by inflammation?
a. Morphine
b. Acetaminophen
c. Ibuprofen
d. Bupivacaine
47. The nurse is reviewing the patient's medication
list and sees that acetaminophen and celecoxib
are scheduled to be administered at the same
time. What should the nurse do?
a. Call the health care provider for an order
to stagger the administration of these two
pain medications.
b. Ask the patient which one he prefers to
take; administer the preferred drug and
assess for relief.
c. Give the acetaminophen because it is
less likely to cause gastric irritation and
bleeding.
d. Administer the medications as ordered
because they can be given together
without ill effects.
Cop yright © 2018, Elsevier Inc. All rights reserved.
48. The nurse sees that during the night the patient
received lorazepam for anxiety, promethazine
for nausea, and hydromorphone for pain.
Which assessment is the most important to
conduct?
a. Closely monitor liver enzymes to identify
early indicators of adverse effects.
b. Watch for symptoms of cardiotoxicity, such
as tingling and cardiac dysrhythmias.
c. Use the Pasero Opioid-Induced Sedation
Scale and check respiratory status.
d. Watch for gastrointestinal distress,
decreased platelet count, and bleeding.
49. An older patient requires an NSAID for
inflammatory pain. The nurse would seek an
order for what type of additional medication
to accompany the NSAID therapy?
a. Anxiolytic, such as alprazolam
b. Nonopioid analgesic, such as acetamino-
phen
c. Proton pump inhibitor, such as lansoprazole
d. Anticonvulsant, such as pregabalin
50. Which concept is most closely aligned with
how a transcutaneous electrical nerve stimula-
tion (TENS) unit works to decrease pain?
a. Comfort
b. Sensory perception
c. Cognition
d. Cellular regulation
51. The nurse is assessing the patient's use of
transdermal fentanyl and discovers that the
patient is making several errors. Which behav-
ior is most likely to result in fentanyl-induced
respiratory depression?
a. Patient is folding the patch in hal£
b. Patient is saving the old used patches.
c. Patient is placing a heating pad over the
patch.
d. Patient is using adhesive tape over the
patch.
Another random document with
no related content on Scribd:
 CHAPTER VI.
REPTON’S MERRY BELLS.

“Barrow’s big boulders, Repton’s merry bells,

Foremark’s cracked pancheons, and Newton’s egg shells.”

Thus does a local poet compare Repton bells with those of

neighbouring parishes. It is not intended to defend the comparison,
for as Dogberry says, “Comparisons are odorous”! but to write an
account of the bells, derived from all sources, ancient and modern.
Llewellynn Jewitt, in Vol. XIII. of the Reliquary, describing the bells
of Repton, writes, “at the church in the time of Edward VI. there were
iij great bells & ij small.” Unfortunately “the Churchwardens’ and
Constables’ accounts of the Parish of Repton” only extend from the
year 1582 to 1635. I have copied out most of the references to our
bells entered in them, which will, I hope, be interesting to my
readers.
Extracts from “the Churchwardens’ and Constables’ accounts of the
Parish of Repton.”

A.D. 1583. The levy for the bell vjˡⁱ ixˢ 0

It’ spent at takying downe the bell xvjᵈ
It’ payd to the Bellfounder xxxiijˢ iijᵈ
It’ bestowed on the s’vants at casting
of ye bell xvjᵈ
It’ expensys drawing up the bell vijᵈ
It’ to the ryngers the xviiᵗʰ day of
november xijᵈ
A.D. 1584. Recevyd of the levy for the bell vjˡⁱ xˢ vijᵈ
It’ of Bretby towards the bell vjˢ viijᵈ
It’ spent at taking downe ye bell viijᵈ
 It’ bestowed on the bell founder ijᵈ
It’ Payd to Bellfounder for weight, i.e.,
iiij score & ij pounds iijˡⁱ xiˢ viijᵈ
A.D. 1585. It’ for a bell rope for the great bell ijˢ
It’ to John Pratt for makinge iiij newe
bellropes vˢ
It’ the day before Saynt Hew’s day for
mendyng the bels, & for nayles viijᵈ
A.D. 1586. It’ of our ladie’s even, given to the
ringers for the preservation of
our Queene xijᵈ
Our ladie’s even, eve of the
Annunciation of the Blessed
Virgin Mary (March 25th).
Preservation of our Queene Elizabeth
from the Babington Conspiracy.
A.D. 1587. It’ given unto the ringers uppon
coronation daye iijᵈ
A.D. 1589. It’ for a bell rope ijˢ viijᵈ
A.D. 1590. It’ payde to francis Eaton for
mendynge the irons aboutt the
bells ijˢ iijᵈ
A.D. 1592. It’ payde to Ralphe Weanwryghte for
trussynge the bells agyne the
Coronacyon daye iijˢ
A.D. 1600. It’ spent in takinge downe ye beell xijᵈ
It’ payd to John Welsh fordowne
takinge hitt donne vjᵈ
It’ spent in lodinge hitt iiijᵈ
It’ spent in charges going with the
beell to Nottingham, being towe
days and one night vjˢ viijᵈ
It’ payd to ye bellfounder for castinge
ye beell iiijˡⁱ xviijˢ
It’ spent with him ijᵈ
It’ payd for yookeinge ye Beell and ijˢ viijᵈ
 for greysse
It’ spent uppon them that holpe with
the beell xᵈ
A.D. 1603. It’ given to the ringers uppon New
yeares daye morninge vjᵈ
It’ given to ye ringers upon St. James
daye (July 25th) xijᵈ
It’ given to ye ringers the v daye of
August xijᵈ
A.D. 1605. It’ payd at hanginge up ye greatte bell vjᵈ
It’ bestowed of ye Ringers at ye first
Ringinge of ye bells vijᵈ
It’ payd for greese for ye bells viijᵈ
A.D. 1607. It’ given to ye Ringers uppon
Christmas daye morning iiijᵈ
A.D. 1614. It’ towe bellclappers
A.D. 1615. The names of them that gave money
to bye the newe beell 80
(Repton, 62. Milton, 18.)
Sum gathered xijˡⁱ viijˢ viijᵈ
A.D. 1623. First paide for castinge the bell vˡⁱ
It’ given to the Ringers at the time of
Prince Charlles his comminge
forth of spaine. (Oct. 1623). xijᵈ

Extract from the diary of Mr. George Gilbert.

“A.D. 1772, Oct. 7th. The third bell was cracked, upon ringing
at Mr. John Thorpe’s wedding. The bell upon being taken
down, weighed 7 cwt. 2 qr. 18lb., clapper, 24lb. It was
sold at 10d. per lb., £35. 18s. Re-hung the third bell, Nov.
21st, 1774. Weight 8 cwt. 3 qr. 24lb., at 13d. per lb., £54.
7s. 8d., clapper, 1 r. 22 lb., at 22d., £1. 2s. 10d. £55. 9s
6½d.”
 This is all the information I can gather about “Repton’s merry bells”
from ancient sources.
For some time our ring of six bells had only been “chimed,” owing
to the state of the beams which supported them, it was considered
dangerous to “ring” them.
During the month of January, 1896, Messrs. John Taylor and Co.,
of Loughborough, (descendants of a long line of bell-founders),
lowered the bells down, and conveyed them to Loughborough,
where they were thoroughly cleansed and examined. Four of them
were sound, but two, the 5th and 6th, were found to be cracked, the
6th (the Tenor bell) worse than the 5th. The crack started in both
bells from the “crown staple,” from which the “clapper” hangs; it (the
staple) is made of iron and cast into the crown of the bell. This has
been the cause of many cracked bells. The two metals, bell-metal
and iron, not yielding equally, one has to give way, and this is
generally the bell metal. The “Canons,” as the projecting pieces of
metal forming the handle, and cast with the bell, are called, and by
which they are fastened to the “headstocks,” or axle tree, were found
to be much worn with age. All the “Canons” have been removed,
holes have been drilled through the crown, the staples removed, and
new ones have been made which pass through the centre hole, and
upwards through a square hole in the headstocks, made of iron, to
replace the old wooden ones. New bell-frames of iron, made in the
shape of the letter H, fixed into oak beams above and below, support
the bells, which are now raised about three feet above the bell
chamber floor, and thus they can be examined more easily.
During the restoration of the Church in 1886, the opening of the
west arch necessitated the removal of the ringers’ chamber floor,
which had been made, at some period or other, between the ground
floor and the groined roof, so the ringers had to mount above the
groined ceiling when they had to ring or chime the bells. There,
owing to want of distance between them and the bells, the labour
and inconvenience of ringing was doubled, the want of sufficient
leverage was much felt: now the ringers stand on the ground floor,
and with new ropes and new “sally-guides” their labour is lessened,
and the ringing improved.
 When the bells were brought back from Loughboro’ I made careful
“rubbings” of the inscriptions, legends, bell-marks, &c., before they
were raised and fixed in the belfry. The information thus obtained,
together with that in Vol. XIII. of the Reliquary, has enabled me to
publish the following details about the bells.
The “rubbings” and “squeezes” for the article in the Reliquary were
obtained by W. M. Conway (now Sir Martin Conway) when he was a
boy at Repton School.
 Plate 6.

REPTON BELL MARKS AND ORNAMENTS.

The 1st (treble) Bell.

On the haunch, between three lines, one above, two below,
 FRAVNCIS THACKER OF LINCOLNS INN ESQᴿ, 1721.

a border: fleurs-de-lis (fig. 7): Bell-mark of Abraham Rudhall, (a

famous bell-founder of Gloucester): border (fig. 7).
A catalogue of Rings of Bells cast by A. R. and others, from 1684-
1830, is in the Bodleian Library, Oxford: this bell is mentioned as the
gift of Francis Thacker.
At the east end of the north aisle of our Church there is a mural
monument to his memory.
The 2nd Bell.
On the crown a border of fleurs-de-lis (fig. 9). Round the haunch,

Is sweetly toling men do call to taste on meats that feed the soule

between two lines above and below, then below the same border
(fig. 9) inverted.

1622 Godfrey Thacker Iane Thacker

This bell is referred to in the Churchwardens’ accounts under

dates 1615 and 1623.
The 3rd Bell.
Round the haunch, between two lines,
THOˢ. GILBERT & IOHN TETLEY CHVRCH WARDENS 1774 PACK & CHAPMAN
OF LONDON FECIT

Below, a border, semicircles intertwined.

This is the bell referred to in the extract quoted above from George
Gilbert’s diary.
The 4th Bell.
Round the haunch, between six lines (3 above and 3 below),

✠ Melodie Nomen Tenet Magdelene

a shield: three bells (two and one), with a crown between them (fig.
1), (Bell mark of Richard Brasyer, a celebrated Norwich Bell founder,
who died in 1513) a lion’s head on a square (fig. 2): a crown on a
square (fig. 3); and a cross (fig. 5).
The 5th Bell.
Round the haunch, between two lines, one above, one below,

✠ Vox du̅ i̅ ihū x̅ r̅ i̅ vox exultarionis

same marks (except the crown) as No. 4 Bell: a king’s head crowned
(fig. 4): and a cross (fig. 6). Below this, round the haunch, a beautiful
border composed of a bunch of grapes and a vine leaf (fig. 8),
alternately arranged.
 Below, the Bell mark of John Taylor and Co. within a double circle,
a triangle interlaced with a trefoil, and a bell in the centre. Above the
circle the sacred emblem of S. John Baptist, the lamb, cross, and
flag. The name of the firm within the circle.
RECAST 1896.
The 6th Bell (the tenor Bell).
Round the haunch, between four lines, two above, and two below,

Hec Campana Sacra Fiat Trinitate Beata GILB THACKAR ESQ IC MW CH

WARDENS 1677

(no bell marks).

Below, a border like that on the fifth Bell.

RECAST 1896.

G. WOODYATT, VICAR.
J. ASTLE, }
CHURCHWARDENS.
T. E. AUDEN, }

Bell mark of J. Taylor and Co. on the opposite side.

(Owing to the difference of the type of the inscription, and names,
it is supposed that this bell was recast in 1677, so it may have been
one of the “three great bells” in Edward VI.’s time.)
The following particulars of the bells have been supplied by
Messrs. John Taylor & Co.

Diameter. Height. Note. Weight.

ft. in. ft. in. cwt. qr. lbs.
No. I. 2 9½ 2 3 C♯ 7 3 19
 ” II. 2 10¾ 2 4½ B 7 2 27
” III. 3 0½ 2 4½ A 8 1 18
” IV. 3 2 2 6½ G♯ 9 2 21
” V. 3 6 2 10 F♯ 12 2 26
” VI. 3 11 3 1 E 17 3 0

Total 3 tons 4 cwts. 0 qrs. 27 lbs.

Key-note E major.
To complete the octave, two more bells are required, D ♯ and E,
then indeed Repton will have a “ring” second to none.
 CHAPTER VII.
THE PRIORY.

THE PRIORY FOUNDED, &c.

Before we write an account of the next most important event in the
history of Repton, viz., the founding of Repton Priory, we must go
back to the year 1059, when Calke Abbey is supposed to have been
founded by Algar, Earl of Mercia. Dr. Cox is of opinion that it was
founded later, at the end of the reign of William (Rufus), or at the
beginning of that of Henry I. circa 1100. About that date a Priory of
Canons regular of St. Augustine, dedicated to St. Giles, was
founded. Many benefactors made grants of churches, lands, &c., a
list of all these will be found in Cox’s Derbyshire Churches, vol. iii., p.
346. There is a curious old Chronicle, written in Latin, by one
T(h)omas de Musca, Canon of Dale Abbey. Each section of the
Chronicle begins with a letter which, together, form the Author’s
name, a monkish custom not uncommon. The section beginning with
an E. (Eo tempore) records the arrival, at Deepdale, of the Black
Canons, as they were called, from Kalc (Calke). Serlo de Grendon,
Lord of Badeley or Bradeley, near Ashbourne, “called together the
Canons of Kalc, and gave them the place of Deepdale.” Here, about
1160, the Canons “built for themselves a church, a costly labour, and
other offices,” which became known as Dale Abbey, in which they
lived for a time, “apart from the social intercourse of men,” but “they
began too remissly to hold themselves in the service of God; they
began to frequent the forest more than the church; more to hunting
than to prayer or meditation, so the King ordered them to return to
the place whence they came,” viz., Calke. During the reign of Henry
II., Matilda, widow of Randulf, 4th Earl of Chester, who died 1153,
granted to God, St. Mary, the Holy Trinity, and to the Canons of
Calke, the working of a quarry at Repton, (Repton Rocks), together
with the advowson of the church of St. Wystan at Repton, &c., &c.,
on condition that as soon as a suitable opportunity should occur, the
Canons of Calke should remove to Repton, which was to be their
chief house, and Calke Abbey was to become subject to it. “A
suitable opportunity occurred” during the episcopate of Walter
Durdent, Bishop of Coventry only, at first, afterwards of Lichfield. He
died at Rome, Dec. 7th, 1159. The usual date given for the founding
of Repton Priory is a.d. 1172, but this must be wrong for the simple
reason that Matilda addresses the Charter of Foundation to Bishop
Walter Durdent, who died, as we saw, in 1159: moreover, the
“remains” of the Priory belong to an earlier date; probably the date
1172 refers to the coming of the Canons from Calke to Repton, as
Dugdale writes, “About the year 1172, Maud, widow of Randulf,
removed the greater part of them here (Repton), having prepared a
church and conventual buildings for their reception.” To those
interested in Charters, copies of the original, and many others, can
be read in Bigsby’s “History of Repton,” Dugdale’s “Monasticon,” and
Stebbing-Shaw’s Article in Vol. II. of “the Topographer,” in which he
has copied several “original Charters, not printed in the Monasticon,”
which were in the possession of Sir Robert Burdett, Bart., of
Foremark, and others.
 Plate 7.

Repton Priory.

The Charters, containing grants, extend from Stephen’s reign,

(1135-1154), to the reign of Henry V., (1413-1422), and include the
church of St. Wystan, Repton, with its chapels of Newton Solney,
Bretby, Milton, Foremark, Ingleby, Tickenhall, Smisby, and Measham,
the church at Badow, in Essex, estates at Willington, including its
church, and Croxall.
In 1278 a dispute arose between the Prior of Repton and the
inhabitants of the Chapelry of Measham, which had been granted to
the Priory about 1271. The chancel of Measham Church was “out of
repair,” and the question was, who should repair it? After
considerable debate, it was settled that the inhabitants would re-
build the chancel provided that the Priory should find a priest to
officiate in the church, and should keep the chancel in repair for ever
after, both of which they did till the dissolution of the Priory.
 In the year 1364 Robert de Stretton, Bishop of Lichfield (1360-
1386), was holding a visitation at Repton in the Chapter House of the
Priory. For some reason or other, not known, the villagers, armed
with bows and arrows, swords and cudgels, with much tumult, made
an assault on the Priory gate-house. The Bishop sent for Sir Alured
de Solney, and Sir Robert Francis, Lords of the Manors of Newton
Solney and Foremark, who came, and quickly quelled this early
“town and gown” row, without any actual breach of the peace. The
monument in the crypt of Repton Church, where it was placed during
the “restoration” of 1792, is supposed to be an effigy of Sir Robert
Frances. “The Bishop proceeded on his journey, and, on reaching
Alfreton, issued a sentence of interdict on the town and Parish
Church of Repton, with a command to the clergy, in the neighbouring
churches, to publish the same under pain of greater
excommunication.” See Lichfield Diocesan Registers.
On October 26th, 1503, during the reign of Henry VII., an
inquisition was held at Newark. A complaint was heard against the
Prior of Repton for not providing a priest “to sing” the service in a
chapel on Swarkeston Bridge, “nor had one been provided for the
space of twenty years, although a piece of land between the bridge
and Ingleby, of the annual value of six marks, had been given to the
Prior for that purpose.”

THE PRIORY DISSOLVED AND DESTROYED.

The Priory of Repton was dissolved in the year 1538. By the
advice of Thomas Cromwell—malleus monachorum—the hammer of
the monks—Henry VIII. issued a commission of inquiry into the
condition, &c., of the monasteries in England. A visitation was made
in 1535, the results were laid before the House of Commons, in a
report commonly known as the “Black Book.” In 1536 an Act was
passed for the suppression of all monasteries possessing an income
of less than £200. a year. By this Act 376 monasteries were
dissolved, and their revenues, £32,000. per annum, were granted to
the King, by Divine permission Head of the Church! Repton Priory
was among them. In the Valor Ecclesiasticus (27 Henry VIII.) the
gross annual value of the temporalities and spiritualities is given as
£167. 18s. 2½d. In 1535, Dr. Thomas Leigh and Dr. Richard Layton,
visited Repton and gave the amount as £180. Also they reported, as
they were expected, that the Canons were not living up to their vows,
&c., &c., and “Thomas Thacker was put in possession of the scite of
the seid priory and all the demaynes to yᵗ apperteynying to oʳ
sov’aigne lorde the Kynges use the xxvj day of October in the xxx
yere of oʳ seid sov’aigne lorde Kyng henry the viijᵗʰ.” There is a very
full inventory of the goods and possessions in the Public Record
Office, Augmentation Office Book, 172. A transcript of this inventory
is given by Bigsby in his History of Repton, also by W. H. St. John
Hope, in Vol. VI. of the Derbyshire Archæological Journal. From this
inventory, and Mr. St. John Hope’s articles in the journal, a very good
account and description can be given of the Priory as it was at the
time of its dissolution.
The dissolved Priory was granted to Thomas Thacker in 1539, he
died in 1548, leaving his property to his son Gilbert. He, according to
Fuller (Church History, bk. vi., p. 358), “being alarmed with the news
that Queen Mary had set up abbeys again (and fearing how large a
reach such a precedent might have), upon a Sunday (belike the
better day, the better deed) called together the carpenters and
masons of that county, and plucked down in one day (churchwork is
a cripple in going up, but rides post in coming down) a most beautiful
church belonging thereto, saying “he would destroy the nest, for fear
the birds should build therein again”.” The destruction took place in
the year 1553. How well he accomplished the work is proved by the
ruins uncovered during the years 1883-4.
This Gilbert died in 1563, as set forth on the mural tablet in the
south aisle of Repton Church, a copy of which I have made, so that
my readers may see what sort of a person he was who “wrought
such a deed of shame.” Gilbert sold the remains of the Priory to the
executors of Sir John Port in 1557, he and his descendants lived at
the Hall till the year 1728, when Mary Thacker, heiress of the Manor
of Repton Priory, left it, and other estates, to Sir Robert Burdett, of
Foremark, Bart. Since that time the Hall has been occupied by the
Headmasters of Repton School.
 REPTON PRIORY DESCRIBED.
The Priory followed the usual plan of monastic buildings, differing
chiefly in having the cloister on the north of its church, instead of the
south. This alteration was necessary owing to the river Trent being
on the north. In choosing a site for monasteries the water supply was
of the first consideration, as everything, domestic and sanitary,
depended on that. The Conventual buildings consisted of Gate-
house, Cloister, with Church on its south side, Refectory or Fratry on
its north. The Chapter Rouse, Calefactorium, with Dormitory above
them, on its east side. Kitchens, buttery, cellars, with Guest Hall over
them, on its west side. The Infirmary, now Repton Hall, “beside the
still waters” of the Trent, on the north of the Priory. The Priory
precincts, (now the Cricket ground), were surrounded by the existing
wall on the west, south, and east sides; on the north flowed, what is
now called, “the Old Trent,” and formed a boundary in that direction.

Plate 8.
 Sir John Porte Knt. The Founder of Repton School. (F. C. H.) (Page 62.)

Gilbert Thacker. (Page 54.)

On the east side of the Priory was the Mill. The wall, with arch-
way, through which the water made its way across the grounds in a
north-westerly direction, is still in situ in the south-east corner of the
Cricket ground. The Priory, and well-stocked fish ponds, were thus
supplied with water for domestic, sanitary, and other purposes.
The bed of the stream was diverted to its present course, outside
the eastern boundary wall, by Sir John Harpur, in the year 1606.
The Gate-house (now represented by the School Arch, which was
its outer arch, and wall) consisted of a square building with an upper
chamber, and other rooms on the ground floor for the use of the
porter. Two “greate gates,” with a wicket door let into one of them, for
use when the gates were closed, or only pedestrians sought for
admission, provided an entrance to the Priory. Proceeding through
the arch-way of the Gate-house, we find ourselves in the precincts.
In the distance, on our left hand, was the Parish Church of St.
Wystan, on our right the Priory Church and conventual buildings.
The Priory Church consisted of nave, with north and south aisles,
central tower, north and south transepts, choir, with aisles, and a
south chapel, and a presbytery to the east of the choir. The Nave (95
ft. 6 in. long, and, with aisles, 51 ft. 8 in. wide) “was separated from
the aisles by an arcade of six arches, supported by clustered pillars
of good design, and must have been one of the most beautiful in this
part of the country, all of exceptionally good character and design,
and pertained to the transitional period of architecture which
prevailed during the reign of Edward I., (1272-1307), when the
severe simplicity of the Early English was merging into the more
flowing lines of the Decorated.” In the north aisle the foundations of
an older church, perhaps the original one, were discovered in 1883-
4.
There were several Chapels in the Nave, two of which are named,
viz., “Oʳ lady of petys Chapell” and the “Chapell of Saint Thomas,”
with images, “reredoses, of wood gylte, and alebaster,” “and a
partition of tymber seled ouerin seint Thom’s Chapell.” “vij. peces of
tymber and lytell oulde house of tymber,” probably the remains of a
shrine, and “xij. Apostells,” i.e. images of them. “j sacrying bell,”
sanctus bell, used during the celebration of the mass. In the floor, in
front of the central tower arch, a slab was discovered, (6 ft. 4 in. by 3
ft. 2 in.), bearing a rudely cut cross, with two steps, and an
inscription, in Old English letters, partly obliterated, round the margin
“(Orate pro) anima magistri edmundi duttoni quondam canonici huius
ecclisie qui obiit ... januarii anno diu mcccclᵒ cui’ ppic (deus Amen).”
This slab is now lying among the ruins at the east end of the Pears
School.
Central Tower (25 ft. by 21 ft. 6 in.) supported by four large piers.
Between the two eastern piers there was a pulpitum, a solid stone
screen (5 ft. 4½ in. deep), with a door in the centre (4 ft. 4½ in.
wide). In the northern half was a straight stone stair leading to the
organ loft above, where was “j ould pair of Organs,” a phrase often
met with in old inventories, and church accounts, in describing that
instrument of music. Through the passage under the screen we
enter the Choir. The step leading down to the choir floor, much worn
by the feet of the canons and pilgrims, is still in situ. The Choir (26 ft.
wide, 31 ft. long) was separated from the south Choir aisle, by an
arcade of five arches, from the north choir aisle, by an arcade of
three arches. All traces of the Canons’ stalls have gone, but there
was room for about thirty-four, thirteen on each side, and four
returned at the west end of the Choir. In the Choir was the High Altar
with “v. great Images” at the back of which was a retable, or ledge of
alabaster, with little images, (on a reredos with elaborate canopies
above them). “iiij lytle candlestyks” and “a laumpe of latten,” i.e., a
metal chiefly composed of copper, much used in church vessels,
also “j rode” or cross.
On the south of the choir was a chapel dedicated to St. John, with
his image, and alabaster table, similar to that in the choir. To the
south of St. John’s Chapel was the “Chapel our Lady” similarly
ornamented, these two chapels were separated from the south
transept by “partitions of tymber,” or screens, the holes in which the
screens were fixed are still to be seen in the bases of the pillars. On
the east of the choir was the Presbytery. In the South Transept was
the Chapel of St. Nicholas with images of St. John and St. Syth, (St.
Osyth, daughter of Frithwald, over-lord of the kingdom of Surrey, and
Wilterberga daughter of King Penda). Of the North Choir Aisle
nothing remains: it is supposed that in it was the shrine of St.
Guthlac, whose sanctus bell is thus referred to by the visitors in their
report “superstitio—Huc fit peregrinatio ad Sanctum Guthlacum et ad
eius campanam quam solent capitibus imponere ad restinguendum
dolorem capitis.” “Superstition. Hither a pilgrimage is made to (the
shrine of) St. Guthlac and his (sanctus) bell, which they were
accustomed to place to their heads for the cure of headache.” The
North Transept was separated from the north choir aisle by an
arcade of three arches, immediately to the east of which the
foundations of a wall, about six feet wide, were discovered, which,
like those in the north nave aisle, belonged to an older building.
Many beautiful, painted canopies, tabernacle work, &c., were found
among the débris of the north transept and aisle, which no doubt
adorned the shrines, and other similar erections, which, before the
suppression of the monasteries, had been destroyed, and their relics
taken away—that is, probably, the reason why we find no mention of
the shrines of St. Guthlac, or St. Wystan in the Inventory.
In the western wall of the North Transept there was a curious
recess (13 ft. 10 in. by 4 ft. 10 in.) which may have been the
armarium, or cupboard of the Vestry, to hold the various ornaments,
and vestments used by the Canons, “j Crosse of Coper, too tynacles,
(tunicles), ij albes, ij copes of velvet, j cope of Reysed Velvet, iiij
towels & iiij alter clothes, ij payented Alterclothes,” &c., &c.
Leaving the Church, we enter the Cloister, through the door at the
east end of the Nave, it opened into the south side of the Cloister (97
ft. 9 in. long by 95 ft. wide). Here were “seats,” and “a lavatory of
lead,” but, owing to alterations, very little indeed is left except the
outside walls. Passing along the eastern side we come to the
Chapter House, the base of its entrance, divided by a stone mullion
into two parts, was discovered, adjoining it on the north side was a
slype, or passage, through which the bodies of the Canons were
carried for interment in the cemetery outside. The slype (11¾ ft. wide
by 25½ ft. long) still retains its roof, “a plain barrel vault without ribs,
springing from a chamfered string course.” Next to the slype was the
Calefactorium or warming room. Over the Chapter House, Slype,
and Calefactorium was the Dormitory or Dorter, which was
composed of cells or cubicles.
The Fratry or Refectory occupied the north side of the Cloister,
here the Canons met for meals, which were eaten in silence,
excepting the voice of the reader. A pulpit was generally built on one
of the side walls, from which legends, &c., were read. Underneath
the Fratry was a passage, leading to the Infirmary, and rooms, used
for various purposes, Scriptorium, &c. At the east end of the Fratry
was the Necessarium, well built, well ventilated, and well flushed by
the water from the Mill race.
At the west end of the Fratry was the Buttery. The west side of the
Cloister was occupied by the Prior’s Chamber, and five others called,
in the Inventory, “the Inner,” “Gardyn,” “Next,” “Halle,” and “Hygh
Chambers.” All were furnished with “fether bedds, &c., &c.,” for the
use of guests, who were received and entertained in this part of the
Priory. Underneath these rooms were “the Kychenn,” “Larder,”
“Bruhouse,” &c., called the Cellarium, over which the Cellarer had
supreme authority. Originally the Cellarium was divided into three
parts, Kitchen, Cellar, and Slype or passage into the south side of
the Cloister. The part assigned to the Kitchen was sub-divided into
three rooms, one on the east side, two on the west. One of these two
(the south) has a vaulted roof, with plain square ribs, the boss where
they meet has been carved, and a part of one of the ribs has been
ornamented with the dog tooth moulding, for about 18 inches, there it
stopped unfinished, in the walls are many recesses for the reception
of “plate,” &c.
The Cellar was a long room (89 ft. by 26 ft.), divided into two
“alleys” by a row of six massive Norman columns, four of which
remain, one has a scollopped capital, the others are plain. The floor
above was divided in a similar manner, with the Prior’s Chamber at
the north end, the Guest Hall, divided into the various rooms
mentioned above, and a chamber over the slype, which was
probably used as a parlour by the guests.