Brunner and Suddarths Textbook of Medical Surgical Nursing 12Th Edition Smeltzer Test Bank Full Chapter PDF

Brunner and Suddarths Textbook of
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Chapter: Chapter 07: Individual and Family Considerations Related to Illness
Multiple Choice
1. A nurse in a wellness center is presenting a class on integrating holistic therapies with

traditional health care. The nurse talks about the trend in health care to treat each patient in a
manner that reconnects his or her total being. Which of the following would best be considered a
holistic approach to health?
A) Physical, emotional, and spiritual well-being
B) Emotional and sexual contact
C) Healthy work environment
D) Financial success and post-secondary education
Ans: A
Chapter: 7
Client Needs: B
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 1
Page and Header: 97, Holistic Approach to Health and Health Care
Feedback: A holistic approach to health reconnects the traditionally separate approach to mind
and body. The connection of physical, emotional, and spiritual well-being must be understood
and considered when providing health care. Options B, C, and D are incorrect because though
they may contribute to a total (or holistic) perception of the patient, they would not be the best
answer to the question.
2. You are the nurse admitting a new patient to your medical-surgical unit. You are completing
an initial health assessment of the patient and document that the patient appears to have an
emotionally healthy attitude. What behaviors would be indicative of an emotionally healthy
attitude?
A) Limiting goal setting
B) Having a sense of humor
C) Avoiding conflict
D) Desire to question reality
Ans: B
Chapter: 7
Client Needs: C
Cognitive Level: Application
Integrated Process: Nursing Process
Objective: 2
Page and Header: 97, Mental Health and Emotional Distress
Feedback: A mentally healthy person accepts reality and has a positive sense of self. Emotional
health is also manifested by having moral and humanistic values and beliefs, having satisfying
interpersonal relationships, doing productive work, and maintaining a realistic sense of hope.
Having hopes and dreams, resolving conflict, setting goals for the future, and having a sense of
humor are all characteristics associated with mental health.
3. A patient admitted to a telemetry unit with complaints of chest pain is a business executive in
a large corporation. During your assessment, you gather data that indicates the patient consumes
7 to 8 ounces of scotch every evening. What is the best indicator of this patient's ability to cope?
A) Maladaptive stress management
B) Inability to satisfy basic needs
C) Behaving in an unrealistic manner
D) Engaging in rewarding behavior
Ans: A
Chapter: 7
Client Needs: C
Objective: 3
Feedback: Drug and alcohol abuse are considered maladaptive ways to manage stress. People
who engage in substance abuse use illegally obtained drugs, prescribed or over-the-counter
medications, and alcohol alone or in combination with other drugs in ineffective attempts to cope
with the pressures, strains, and burdens of life. The other options are all indicators of this
patient's ability to cope, but they are not the best indicator.
4. As the nurse caring for a 25-year-old patient who has recently been diagnosed with testicular
cancer, you know that this patient's illness will impact every aspect of his life. What
developmental tasks might you expect to be affected?
A) Achieving self-actualization
B) Marrying and starting a family
C) Reviewing life's accomplishments
D) Establishing financial security
Ans: B
Chapter: 7
Client Needs: C
Objective: 6
Page and Header: 103, Family Health and Distress
Feedback: It is within families that people grow, are nurtured, acquire a sense of self, develop
beliefs and values about life, and progress through life's developmental stages. Developmental
tasks associated with young adulthood include marrying and starting a family. The other options
are incorrect because achieving self-actualization, reviewing life's accomplishments, and
establishing financial security are not developmental tasks for this stage of the patient's life.
5. You are the nurse caring for a young female patient who has just been diagnosed with
multiple sclerosis. The patient is in her early 30s and is the mother of two children under the age
of 5 years. After hearing this news, what initial emotional symptom would the nurse anticipate
the patient will most likely experience?
A) Lethargy
B) Bargaining
C) Lack of interest
D) Anxiety
Ans: D
Chapter: 7
Client Needs: C
Objective: 4
Feedback: In clinical settings, fear of the unknown, unexpected news about one's health, and
impairment of bodily functions engenders anxiety. Lethargy and lack of interest would be
manifestations of depression that might follow the anxiety. Bargaining is a stage of grief and
would not be an initial emotional symptom.
6. The clinic nurse is caring for a patient who has recently been involved in an automobile
accident. The patient was the driver of the car and his passenger died. The patient arrives in the
clinic with complaints of nightmares, inability to concentrate, and impaired memory. What
would you know the patient is most likely experiencing?
A) Posttraumatic stress disorder
B) Developmental difficulties
C) Drug addiction
D) Mild stress
Ans: A
Chapter: 7
Client Needs: C
Objective: 4
Feedback: Patients with posttraumatic stress syndrome have difficulty sleeping, an exaggerated
startle response, excessive vigilance, increased urinary epinephrine levels, and increased body
metabolism. The symptoms the patient is experiencing are not indicative of developmental
difficulties, drug addiction, or mild stress.
7. A nurse working in a behavioral health facility cares for patients with various symptoms.
Based on the patients' symptoms, which patient would the nurse identify as being at an increased
risk for suicide?
A) A 35-year-old man with anxiety
B) A person with a family history of suicide
C) A person with an inability to form trusting relationships
D) A person with loss of interest in career
Ans: B
Chapter: 7
Client Needs: C
Objective: 3
Feedback: Risk factors for suicide include a family history of suicide. Anxiety, loss of interest,
and poor personal relationships may contribute to depression but are not risk factors of suicide.
8. You are a nurse working in a drug rehabilitation facility. You are discussing codependent
behaviors with the husband of a patient who is addicted to alcohol. Which behavior of the
husband would be considered a codependent behavior?
A) Calling in sick at work on behalf of a hungover spouse
B) Showing anger because the wife has relapsed
C) Verbalizing a desire to end the marriage
D) Discussing the addiction with his wife
Ans: A
Chapter: 7
Client Needs: C
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 6
Feedback: Caring for codependent family members is another nursing priority. Codependent
people struggle with the urge to control others and a willingness to remain involved and suffer
with a person who has a drug problem. This may include covering up the loved one's addiction.
Becoming angry because of a relapse, verbalizing a desire to end the marriage, or discussing the
addiction with his wife would not be considered codependent behaviors.
9. You are caring for a patient who has recently been told that she is terminally ill. The woman
says to you, “If only I could live until my granddaughter has her first birthday.” In what stage of
grief would you assess this patient to be?
A) Disbelief
B) Anger
C) Acceptance
D) Bargaining
Ans: D
Chapter: 7
Client Needs: C
Cognitive Level: Analysis
Objective: 5
Page and Header: 104, Loss and Grief
Feedback: The patient's prayers to God for a few more months to live reflect the bargaining
stage of grief. Therefore the other answers are incorrect.
10. The three children of a 75-year-old woman are being counseled by a hospice nurse. Their
mother recently died from breast cancer, and the three children are experiencing differing stages
of grief. The hospice nurse discusses the grieving process with the three children. What would
the nurse define as a basic goal of the grieving process?
A) Healing the self
B) Constant reflection on the loss
C) Encouraging sadness and depression
D) Effectively role-modeling loss for offspring
Ans: A
Chapter: 7
Client Needs: C
Objective: 4
Feedback: The grieving process may be different in duration for each person experiencing a
loss. There are two basic goals of grieving: healing the self and recovering from the loss.
Constant reflection on the loss, the encouraging of sadness and depression, or effectively
role-modeling loss for offspring are not basic goals of the grieving process.
11. As a hospice nurse caring for terminally ill patients, part of your nursing care is to assist the
terminal patient to stimulate, regain, or strengthen a connection within his or her inner self. How
might the nurse accomplish this?
A) Inquire about the patient and his or her family's need for spiritual care
B) Have the patient transferred home
C) Have the patient keep a journal
D) Have a hospital volunteer read to the patient on a daily basis
Ans: A
Chapter: 7
Client Needs: C
Objective: 7
Page and Header: 105, Spirituality and Spiritual Distress
Feedback: A simple assessment the nurse can make is to inquire about the patient and his or her
family's need for spiritual care. This shows the nurse supports a potential need for spiritual care.
Having the patient transferred home or having him or her keep a journal would not demonstrate
the nurse's support for a potential need for spiritual care. Having someone read to the patient on a
daily basis is not an action that would assist the patient to strengthen a connection with his or her
inner self.
12. The nurse practitioner at a metropolitan college is seeing a 20-year-old student who
presents at the student health center during finals week with vague complaints of “stomach
problems.” The student tells the nurse practitioner that she broke up with her boyfriend in the
first week of the semester and has not been feeling well or doing well in school since. What
would the nurse practitioner be aware of?
A) The “stomach problems,” may be cardiac related and she could be in danger.
B) The boyfriend is the core issue, and a plan of care that addresses his influence is important.
C) The girl is probably not telling the truth and could be in an abusive relationship.
D) The “stomach problems” are likely related to stress and depression.
Ans: D
Chapter: 7
Client Needs: A-2
Objective: 4
Feedback: People who are depressed often seek health care for somatic manifestations of
depression such as stomach problems, fatigue, and/or inability to cope with their activities of
daily living, like work or school. Option A is a valid concern, but she has not been feeling well
for a long period of time, and cardiac risk in low in this age group. Option B and C are incorrect;
the situation requires an assessment first before the boyfriend is included in the diagnosis or we
assume the girl is not telling the truth.
13. The nurse is meeting with a family that is facing the death of their father. The family tells
the nurse they are looking for ways to help him and themselves during this period. In order to
help this family, what would the nurse need to do first?
A) Assess the faith needs of the group
B) Diagnose any faith-related problems and evaluate their ability to provide spiritual care for
themselves
C) Inform the family it is out of the nurse's scope of care to provide spiritual guidance
D) Contact clergy to provide professional guidance
Ans: A
Chapter: 7
Client Needs: A-1
Difficulty: Easy
Objective: 8
Feedback: The first step in the nursing process is always assessment. Nurses are capable of
providing spiritual care as long as they are present and supportive when patients experience
doubt, fearfulness, suffering, despair, or other difficult psychological states of being. Option B is
incorrect; assessment is always completed prior to diagnosis of the actual or potential problems.
Option C is incorrect; nurses are capable of providing spiritual care by being present and
supportive. Option D is incorrect; again, an assessment would be completed prior to contacting
clergy.
14. Your patient is a 49-year-old woman who is terminally ill with metastatic breast cancer. She
has been coping with her impending death by speaking at cancer conventions, putting her affairs
into order and looking inward for answers. The family talks with the nurse about their loved
one's activities. What is the nurse aware of regarding these activities?
A) The activities could be spiritual in nature and the family would benefit if they were included
whenever possible.
B) The activities may result in dysfunctional behaviors and denial, which alienates the family.
C) The activities represent the need to control her final days by showing the world and her
family that she is fine.
D) The activities need to be addressed and limited so she spends time with her family, or it will
result in dysfunctional grieving when she dies.
Ans: A
Chapter: 7
Client Needs: A-2
Objective: 7
Feedback: Often, spiritual behavior is expressed through sacrifice, self-discipline, and spending
time in activities that focus on the inner self or the soul. The families of people who are
terminally ill may feel disconnected with their loved one during this period, and they need to be
included in activities important to their loved one whenever possible. Option B is incorrect; any
positive behavior in excess may result in dysfunctional behaviors, but there is no evidence that
“she is in denial and alienating her family.” Option C is incorrect; there is no evidence that she
“needs to control her final days, by showing the world and her family that she is fine.” Option D
is a valid concern, but the answer is stated in absolute terms; there is no evidence that that she is
spending too much time pursuing spiritual behaviors or that the family is uninvolved.
15. A 45-year-old woman presents at the free clinic stating that she needs help. While talking
with this patient, the nurse illicit information about the woman's situation, including the fact that
her husband “drinks heavily.” Because of this, the patient feels that her family is being ruined.
What nursing intervention would be the best for this patient?
A) Call husband's family and friends to obtain support for an intervention.
B) Allow the woman to express her feelings and assess for codependent behaviors.
C) Call the police and have the man arrested for alcohol abuse and have him hospitalized.
D) Remind the woman that her husband's alcohol problem is not her fault and that it is simply a
defect in her husband's character.
Ans: B
Chapter: 7
Client Needs: A-1
Integrated Process: Communication and Documentation
Objective: 5
Feedback: Assessment of the problem requires the women to first express her feelings and then
assess her position in the relationship. Codependent people tend to manifest unhealthy patterns in
relationships with others, and the family dynamics need to be assessed prior to diagnosis and the
development of a care plan. Option A is incorrect; it would be premature to call the husband's
family and friends to obtain support for an intervention. Option C is incorrect; the husband has
done nothing illegal at this point. Option D, reminding the women that her husband's alcohol
problem is not her fault, would be appropriate, but alcoholism is a disease, not a defect in her
husband's character.
16. The home health nurse has been caring for a 90-year-old patient who remains independent
in her home setting. This patient has reached a point where she needs help to remain at home.
The nurse meets with the family to discuss the situation and develop a plan of care for this
patient. The family is arguing about who is going to provide that care or who will pay for it.
What would the nurse's plan of care focus on?
A) Determining who is going to be involved in the care of the patient so that assignments can
be given
B) Allowing the patient to negotiate the situation with her family to create trust and
understanding
C) Providing family access to a professional problem solver, such as an attorney, to provide
legal advice to the woman
D) Assessing and facilitating family-member communication and designing interventions that
focus on coping behaviors
Ans: D
Chapter: 7
Client Needs: B
Objective: 6
Feedback: The plan of care would need to assess family functioning to determine how the
particular family will cope with the women's changing health and increased family
responsibilities. If the family is chaotic or disorganized, promoting coping behaviors becomes a
priority in the plan of care. Option A, assessing who is going to be involved in the care of the
patient is a good start, but “giving assignments” is inappropriate. Option B is incorrect; the nurse
should always work as an agent for the patient to help to facilitate a plan of care, especially when
the family is not coping well. Option C is incorrect; the professional problem solver in this case
needs to be the nurse.
17. You are a community nurse who is attending a clinic at the local senior center. An elderly
man approaches you and shares his concern that his stress level is affecting his ability to cope
with many of his activities of daily living. The man tells you that while he was growing up, his
family didn't get along well, and the man feels that this is the reason he has “struggled with his
emotions in the past.” What would be your best response to this patient?
A) “Family experience and early childhood experiences often have little influence on our
coping ability, and stress is often related to needless worry.”
B) “Coping is determined by our own attitude and how we decide to view our family life today;
you need to try to take control of your behavior to decrease your stress level.”
C) “Family experience and early childhood experiences will often influence a person's ability to
cope, and exploring these issues may help relieve stress.”
D) “Children raised in dysfunctional homes may become mentally ill later in life and need to be
medicated; do you feel like medication may help?”
Ans: C
Chapter: 7
Client Needs: D-4
Objective: 2
Feedback: Coping ability is strongly influenced by family and childhood experiences.

Typically, people revert to the strategies observed early in life used by their family members.
The patient is already exploring the issue and has connected being “raised in a family that did not
get along well” with coping and is now struggling with his emotions, which is an appropriate
coping strategy. Option A is incorrect; coping ability is strongly influenced by family and
childhood experiences, and telling the patient “stress is often related to needless worry,"
minimizes his concern. Option B is incorrect; coping is not determined by our own attitude; it is
a continuous dynamic process. Option D is incorrect; the answer offers misinformation and
assumes the patient is mentally ill and then offers an intervention without sufficient evidence.
18. Following the death of her youngest daughter, the patient is in an acute depression. The
patient is on high-dose antidepressants and feels that the medicine is not helping her. She says to
the nurse “I hurt so bad, why don't the drugs make the pain go away?” What would be the nurse's
best response?
A) “The antidepressants will only work if you are willing to help yourself, so you need to try
harder.”
B) “Your sense of well-being will return in about a year when you forget about the death of
your daughter.”
C) “The medications help balance chemicals in our bodies during periods of depression, but
they do not fix the losses and stress that created the imbalance.”
D) “The key to the medication working is taking the medication correctly; are you taking it
every day at the same time and dose?”
Ans: C
Chapter: 7
Client Needs: D-4
Objective: 2
Page and Header: 97, The Brain and Physical and Emotional Health
Feedback: The balancing of neurotransmitters provided by antidepressants will not replace the
grieving process or replace the loss of a loved one. The health care community should place as
much emphasis on emotional health as it places on physiologic health and should recognize how
biologic, emotional, and societal problems combine to affect individual patients, families, and
communities. Option A is incorrect; “trying harder” is a value judgment and will not balance
neurotransmitters. Option B is incorrect; the patient may learn to cope with her daughter's death,
but she will never “forget about it,” and offering a one-year timeframe for grieving is
inappropriate. Option D is incorrect; it is important for the patient to take the medicine correctly,
but is not the key to curbing her depression.
19. You are the nurse caring for a person newly diagnosed with diabetes, and you are
developing a holistic plan of care for this patient. You know that for this plan of care to be
successful, it must what?
A) Take into account the cost of care
B) Connect families, friends, and the environment
C) Provide a connection between medicine and nursing
D) Address the disease but also incorporate the mind, body, and spirit
Ans: D
Chapter: 7
Client Needs: A-1
Difficulty: Easy
Objective: 1
Feedback: A holistic plan of care seeks to balance and integrate the use of crisis medicine and
advanced technology along with the mind, body, and spirit, which are incorporated though the
use of the nursing process. Option A is incorrect; taking into account the cost of care is only one
facet of a holistic picture. Option B, connecting families, friends, and the environment, is
important, but mind, body, and spirit define holism. Option C is incorrect; a holistic plan of care
may provide a connection between medicine and nursing, but it does not define it.
20. A nurse working in a senior center is giving a talk on grief and loss. The nurse encounters a
patient who, over the last 6 months, has lost his spouse as well as several friends and family
members. How can the nurse best assist the patient?
A) Recommend that the patient get over the loss and move on with his life
B) Encourage the patient to participate in grief counseling
C) Suggest that the patient move into a senior residence to reminder him of his wife
D) Ask another elder member of the senior center to discuss his experiences with grief with the
patient
Ans: B
Chapter: 7
Client Needs: C
Integrated Process: Caring
Objective: 8
Feedback: In most instances, the grieving spouse will benefit from grief counseling. Some
patients do better in group counseling; others prefer individual counseling. Recommending that
the patient move on with his life ignores the reality that the patient must move through the stages
of grief at his own pace. If moving into a senior residence is the best option for a grieving
spouse, he should be advised to do so only after a period of counseling. Ignoring the patient's
grieving doesn't validate his feelings or help him progress through the stages of grief.
Multiple Selection
21. The nursing instructor is discussing holistic health care with her nursing students. The
instructor talks about the different factors the nurse must consider when creating a holistic plan
of care. What are these factors? (Mark all that apply.)
A) The patient's physical environment
B) The patient's developmental life stage
C) The patient's emotional context
D) The patient's conceptual integration of life
E) The patient's physiologic health condition
Ans: B, C, E
Chapter: 7
Client Needs: B
Objective: 1
Feedback: It is the nurse's conceptual integration of the physiologic health condition within the
emotional and social context, along with the patient's developmental life stage, that allows for
the development of a holistic plan of nursing care. The patient's physical environment and his or
her “conceptual integration of life” are not factors the nurse would take into account when
creating a holistic plan of care.
Multiple Choice
22. Nursing, as a profession, has long held the belief that providing nursing care to an
individual patient means providing nursing care to the entire family. What does this mean when
put into a holistic framework of patient care?
A) Families are caretakers even when the patient is not acutely ill.
B) It is necessary for the nurse, patient, and the patient's family to integrate the physical and
emotional environment of the patient.
C) Active participation by individuals and families in health promotion is integral to this
framework of patient care.
D) This model is congruent with the philosophy of traditional patriarchal medicine.
Ans: C
Chapter: 7
Client Needs: B
Objective: 1
Feedback: Active participation by individuals and families in health promotion supports the
self-care model historically embraced by the nursing profession. This model is congruent with
the philosophy that seeks to balance and integrate the use of traditional medicine and advanced
technology with the influence of the mind and spirit on healing. Families are not always
caretakers when the patient is not acutely ill; it is not necessary for the nurse, patient, and the
patient's family to integrate the physical and emotional environment of the patient. It is necessary
for the patient to integrate his or her physical and emotional environments. The holistic
framework of patient care is not a model that is congruent with the philosophy of traditional
patriarchal medicine.
23. You are admitting a patient who is terminally ill to the hospice facility where you work.
Part of the admission process is assessing the patient's spiritual strength. Which question would
you be sure to ask during the assessment of a patient's spiritual strength?
A) Do you have adequate family support?
B) How do you perceive yourself?
C) Have your spiritual beliefs and values changed since you became ill?
D) How does your family perceive you?
Ans: C
Chapter: 7
Client Needs: C
Difficulty: Easy
Objective: 7
Feedback: The nurse assesses spiritual strength by inquiring about the patient's sense of
spiritual well-being, hope, and peacefulness and assesses whether spiritual beliefs and values
have changed in response to illness or loss. Inquiring about family support and how the family
perceives the patient are not assessments of the patient's spiritual strength. The patient's
self-image is also not an assessment of the spiritual strength of the patient.
24. A young woman comes to the clinic where her primary care provider (PCP) works. She
asks to speak with the nurse. The patient says she has just come from the surgeon's office where
her PCP referred her and that the she has been told she is terminal. She says she felt she should
let her PCP know the results of her tests and that she has chosen to receive only palliative care
now. The woman is calm, smiles often, and exhibits no outward signs of anxiety. While speaking
with the nurse, the patient says that she needs to go home and talk to her family. The nurse asks
if she can do anything for the patient and is told by the patient “No, this will not be easy, I know,
but I am sure that my faith will not fail me.” What is the best way for the nurse to document the
patient's meeting with her?
A) “Patient feels that her physiologic condition will give her the strength to complete her final
tasks.”
B) “Patient feels that her spiritual belief will give her the strength to complete her final tasks.”
C) “Patient feels that her physical integrity will give her the strength to complete her final
tasks.”
D) “Patient feels that her congruent lifestyle will give her the strength to complete her final
tasks.”
Ans: B
Chapter: 7
Client Needs: C
Difficulty: Easy
Objective: 7
Feedback: Faith, considered the foundation of spirituality, is a belief in something that a person
cannot see. The spiritual part of a person views life as a mystery that unfolds over the lifetime,
encompassing questions about meaning, hope, relatedness to God, acceptance or forgiveness,
and transcendence. Nowhere in the scenario is it indicated that the patient feels her physiologic
condition, her physical integrity, or her congruent lifestyle will get her through this last part of
her life.
25. A 59-year-old man is being admitted to hospice care that will be given in his home. While
doing the admission assessment, the hospice nurse asks about the man's spiritual beliefs. The
man tells the nurse that he is of the Baha'i faith and that he is strong spiritually. What does the
hospice nurse realize about her patients' beliefs?
A) The spiritual beliefs of people and families are all basically the same and do not need
addressing.
B) The spiritual beliefs of people and families never cause tension and concern when a patient
is terminal.
C) The spiritual beliefs of people and families need to be acknowledged, valued, and respected.
D) The spiritual beliefs of people and families often cause misdirection and discomfort to those
who hold different beliefs.
Ans: C
Chapter: 7
Client Needs: C
Objective: 7
Feedback: It is important that the spiritual beliefs of people and families be acknowledged,
valued, and respected for the comfort and guidance they provide. The spiritual beliefs of patients
and their families are not basically the same, and they do need to be addressed. Spiritual beliefs
can cause tension and concern among family members when a family member is terminal.
Spiritual beliefs do not generally cause misdirection of family members who do not subscribe to
the beliefs. They can, however, cause discomfort to family members who hold different beliefs.
26. The nurse is caring for an elderly man who has just been diagnosed with Alzheimer's
disease. This man does not communicate with his family or his care providers easily. The nurse
knows the best plan of care would emphasize ways for the patient to
A) distinguish sources of pain.
B) talk about his life goals.
C) detect events that connect him with others.
D) verbalize feelings and fears.
Ans: D
Chapter: 7
Client Needs: C
Difficulty: Easy
Objective: 8
Feedback: Caring strategies emphasize ways for the patient to verbalize feelings and fears and
to identify sources of anxiety. The part of the care plan pertaining to communication would not
emphasize distinguishing sources of pain. Finding ways for the patient to talk about his life goals
and to verbalize his feelings and fears would be addressed, but the best plan of care would not
emphasize these interventions.
27. You are caring for a patient diagnosed with an anxiety disorder. The patient's anxiety has
led to social and emotional isolation. The patient tells the nurse that he is now in danger of losing
his job because of their high levels of anxiety. What are the priorities of care for this patient?
A) Learning his anti-anxiety drug regimen
B) Use of relaxation techniques
C) Communicating his sources of anxiety with his supervisor
D) Notifying family members of an impending job loss
Ans: B
Chapter: 7
Client Needs: C
Difficulty: Easy
Objective: 8
Feedback: All nurses must be vigilant about patients who worry excessively and deteriorate in
emotional, social, or occupational functioning. The need to teach and promote effective coping
abilities and the use of relaxation techniques are the priorities of care. Therefore options A, C,
and D are incorrect.
Multiple Selection
28. The initial assessment of a patient has many aspects. What types of information would the
nurse illicit during an initial assessment? (Mark all that apply.)
A) Instituting nursing interventions
B) Identifying treatment protocols
C) Identifying substance abuse problems
D) Directing treatment protocols
E) Need for referrals
Ans: B, C, E
Chapter: 7
Client Needs: D-4
Objective: 8
Feedback: Health care professionals are in pivotal positions to identify substance abuse
problems, institute treatment protocols, and make referrals. Option A is incorrect: it is not
obtaining information; it is beginning the use of nursing interventions. Option D is incorrect
because it is also not obtaining information; it is managing the patient's treatment protocols.
Multiple Choice
29. You are caring for a 49-year-old mother of three teenagers. Your patient has been
diagnosed with pancreatic cancer that has already spread throughout her body. The patient tells
you that her family is already experiencing difficulties because her husband has lost his job and
her sister's family has been staying with them for a month since losing their home in a fire. As
the nurse, what do you know about family participation in this patient's current health situation?
A) The family's stability lies in its numbers.
B) The person who will participate most in the current health situation is the patient's sister.
C) The loss of the husband's job does not impact the current health situation.
D) The family may require additional assistance before they can become involved in the current
health situation.
Ans: D
Chapter: 7
Client Needs: D-4
Difficulty: Easy
Objective: 6
Feedback: The family with preexisting problems may require additional assistance before
participating fully in the current health situation. Option A is incorrect because nothing in the
scenario indicates that the family becomes more stable as it gets larger. Option B is incorrect
because the scenario does not indicate who will participate most in the patient's health situation.
Option C is incorrect because the husband's loss of his job and the resultant financial effects will
impact the current health situation.
Multiple Selection
30. You are a nurse working on a hospice team. The team is admitting a patient with a
diagnosis of stage IV colon cancer. What are the functions of the health care team? (Mark all that
apply.)
A) Facilitating the construction of a social support system
B) Continually assessing the occupational environment
C) Developing interventions created to handle the stressors
D) Implementing specified treatment protocols
E) Directing multigenerational task assignments
Ans: A, C, D
Chapter: 7
Client Needs: D-4
Objective: 6
Feedback: Ideally, the health care team conducts a careful and comprehensive family
assessment, develops interventions tailored to handle the stressors, implements the specified
treatment protocols, and facilitates the construction of social support systems. Assessing the
occupational environment and directing multigenerational task assignments are not functions of
the health care team.
Multiple Choice
31. The nurse caring for a 44-year-old female patient becomes concerned about the patient's
ineffective coping behaviors. What behavior exhibited by the patient would indicate to the nurse
that the patient is coping ineffectively?
A) Spiritual fulfillment
B) Compassionate caring
C) Denial and blaming
D) Severe family conflict
Ans: C
Chapter: 7
Client Needs: C
Difficulty: Easy
Objective: 3
Feedback: Often, denial and blaming of people occur. Sometimes, physiologic illness,
emotional withdrawal, and physical distancing are the results of severe family conflict, violent
behavior, or addiction to drugs and alcohol. Spiritual fulfillment and severe family conflict are
not behaviors so these options are incorrect. Compassionate caring is not a behavior that would
indicate ineffective coping.
32. A man comes to the clinic complaining of feeling “unhappy.” As the nurse caring for this
patient, what would you know happens as the patient's tension grows?
A) Coping behaviors improve
B) Social interactions become more important
C) Financial concerns become less important
D) Security and survival are threatened
Ans: D
Chapter: 7
Client Needs: C
Difficulty: Easy
Integrated Process: Caring
Objective: 2
Feedback: When people have unmet emotional needs or distress, they experience an overall
feeling of unhappiness. As tension escalates, security and survival are threatened. As the patient's
tension grows, coping behaviors do not improve, social interactions become less important, and
financial concerns can be either positively or negatively impacted.
33. A 16-year-old boy asks to speak with the nurse at the mental health clinic where his family
is receiving counseling. He tells the nurse that his father's drinking is getting worse and the boy
is afraid that his father will hurt his mother. The boy asks the nurse what can be done. What
would be the best response by the nurse?
A) “We can plan a therapeutic intervention.”
B) “Nothing, this is between your mother and your father.”
C) “We can work with you to learn to protect your mother.”
D) “We should encourage your father to get better.”
Ans: A
Chapter: 7
Client Needs: A-2
Objective: 5
Feedback: Families may approach the health care team to help set limits on the dysfunctional
behavior of people who abuse substances. At these times, a therapeutic intervention is organized
for the purpose of confronting the patient about substance use and the need to obtain drug or
alcohol treatment. Option B is incorrect as it does not provide the necessary information and
support to the boy. Option C is incorrect because the nurse would not work with the patient to
learn to protect his mother. Option D is incorrect because encouraging the father “to get better”
implies that the substance-abuse problem is a problem the father has chosen to have.
34. The assessment of substance abuse by a patient is an important part of the assessment
process every nurse goes through with her patients. What combination of factors would the nurse
know predisposes a patient to the possibility of substance use and/or abuse?
A) Family interrelationships
B) Values
C) Personal norms
D) Current political environment
E) Motivation for cure
Ans: B
Chapter: 7
Client Needs: B
Objective: 5
Feedback: The combination of factors, such as values and beliefs, family and personal norms,
spiritual convictions, and conditions of the current social environment, predisposes a person to
the possibility of drug use, motivation for treatment, and continual recovery.
35. A 32-year-old male diagnosed 10 years ago with leukemia has just been informed that he
has relapsed and must start chemotherapy again. How does the nurse know this patient might
respond?
A) With partial capitulation syndrome
B) With affective dysfunction disorder
C) With bargaining
D) With confusion
Ans: C
Chapter: 7
Client Needs: C
Objective: 6
Feedback: People with physical health problems, such as diabetes mellitus, human
immunodeficiency virus (HIV), infection/acquired immunodeficiency syndrome (AIDS), cardiac
disorders, gastrointestinal disorders, disabilities, and neurologic impairments, tend to respond to
these conditions with feelings of loss and grief. Options A and B are incorrect because there is no
such thing as partial capitulation syndrome, and a patient who is chronically ill would generally
not be pushed into a mental/emotional health diagnosis because of becoming more acutely ill.
Option D is incorrect because a patient dealing with a chronic illness would not generally react
with confusion to news of an exacerbation of that illness.
36. The mother of a 14-year-old boy is distraught over her son's conversion from a diagnosis of
HIV infection to a diagnosis of AIDS. What feelings would this mother most likely exhibit?
A) Confusion and denial
B) Anger and control
C) Grief and isolation
D) Loss and grief
Ans: D
Chapter: 7
Client Needs: C
Objective: 4
Feedback: The families of people with physical health problems, such as diabetes mellitus,
human immunodeficiency virus (HIV), infection/acquired immunodeficiency syndrome (AIDS),
cardiac disorders, gastrointestinal disorders, disabilities, and neurologic impairments, tend to
respond to these conditions with feelings of loss and grief. Options A, B, and C are incorrect;
even though the mother may have these feelings, they are not the feelings she would most likely
exhibit in this scenario.
37. You are the nurse caring for a 52-year-old woman who was diagnosed 15 years ago with
multiple sclerosis (MS). The woman has been hospitalized on your unit for the past 5 days
receiving IV steroid infusions for an acute exacerbation of her disease. What would be the most
important assessment need for this woman with MS?
A) Loneliness
B) Aggression
C) Visual problems
D) Tremors
Ans: A
Chapter: 7
Client Needs: C
Objective: 3
Feedback: Health care providers must be aware that women with MS need to be assessed for
loneliness because loneliness is a precursor to depression. Aggression, visual problems, and
tremors are important aspects to assess because they all can be side effects of the steroid
infusions the patient has been receiving. Therefore, if these effects were exhibited, they would
not be the result of the disease process or the patient's ability to cope and would not be the most
important for the nurse to assess.
38. Five functions have been identified as being essential to the growth of individuals and
families. One of these functions is education and support. How is support manifested in the
context of coping with crisis and illness situations?
A) Making clear distinctions between the generations
B) Actions that tell family members they are cared about and loved
C) The promotion of exercise in the lifestyle
D) Transmitting culture and acceptable behaviors
Ans: B
Chapter: 7
Client Needs: B
Objective: 5
Feedback: Five family functions are viewed as essential to the growth of individuals and
families. The first function, management, involves the use of power, decision making about
resources, establishment of rules, provision of finances, and future planning — responsibilities
assumed by the adults of the family. The second function, boundary setting, makes clear
distinctions between the generations and the roles of adults and children within the family
structure. The third function, communication, is important to individual and family growth;
healthy families have a full range of clear, direct, and meaningful communication among their
members. The fourth function is education and support. Education involves modeling skills for
living a physically, emotionally, and socially healthy life. Support is manifested by actions that
tell family members they are cared about and loved; it promotes health and is seen as a critical
factor in coping with crises and illness situations. The fifth function, socialization, involves
families' transmission of culture and the acceptable behaviors needed to perform adequately in
the home and in the world. Therefore options A, C, and D are incorrect responses.
39. You are caring for the 27-year-old mother of 2-year-old twins. She was diagnosed 18
months ago with primary progressive multiple sclerosis and has just been told that she will
probably be confined to a wheelchair within a few months. When the home health nurse makes a
routine visit to the patient, the nurse finds her tearful, lethargic, and appearing disheveled. The
patient tells the nurse, “I used to think I could cope with this awful disease, but I just don't know
anymore. I have become such a disaster that I can't do anything anymore.” What behaviors in the
patient would lead the nurse to suspect acute depression in this patient?
A) Increased self-esteem
B) Claims of improvement in function
C) Changes in the patient's thoughts or feelings
D) Denial of physical progression of the disease
Ans: C
Chapter: 7
Client Needs: C
Objective: 3
Feedback: Any loss in function, change in role, or alteration in body image is a possible
antecedent to depression. Nurses in all settings encounter patients who are depressed or who
have thought about suicide. Depression is suspected if changes in the patient's thoughts or
feelings and a loss of self-esteem are noted. Increased self-esteem would not indicate depression;
it would indicate alterations in coping for this patient. Claims of improvement in function and
denial of the physical progression of the disease are also not indications of depression. Denial is
a stage in the grieving process, and claims of functional improvement are a means of denial of
the progression of the disease.
40. You are a nurse working in an outpatient mental health facility which is part of the
Veterans' Administration system. You are case manager for a group of young veterans who have
returned from Iraq and Afghanistan within the past 18 months. The patients are considered
physically compromised and are struggling emotionally. Most of these patients have a diagnosis
of post-traumatic stress disorder (PTSD). What does the sensitivity of the nurse create that lets
her work with these patients?
A) An empathetic relationship
B) A compassionate relationship
C) A social relationship
D) An interpersonal relationship
Ans: D
Chapter: 7
Client Needs: C
Objective: 4
Feedback: The sensitivity and caring of the nurse creates the interpersonal relationship
necessary to work with patients who have PTSD. These patients are physically compromised and
are struggling emotionally with situations that are not considered part of normal human
experience — situations that violate the commonly held perceptions of human social justice.
While empathy and compassion are positive attributes when caring for all patients, it is the
building of a strong interpersonal relationship between the nurse and the patient that allows the
nurse to care for a patient with PTSD. A social relationship between the nurse and the patient is
not necessary for the nurse to provide care to any patient.
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“Oh, I could not choose but go
Into the woodlands hoar.
“Into the blithe and breathing air,

Into the solemn wood,
Solemn and silent everywhere!
Nature with folded arms seem’d there,
Kneeling at her evening prayer!
Like one in prayer I stood.
“Before me rose an avenue

Of tall and sombrous pines;
Abroad their fanlike branches grew,
And where the sunshine darted through,
Spread a vapour soft and blue.
In long and sloping lines.
“And falling on my weary brain,

Like a fast falling shower,
The dreams of youth came back again;
Low lispings of the summer rain,
Dropping on the ripen’d grain,
As once upon the flower.”
He told her of his happy progress, from that first dawning of hope to the full
joy of steadfast faith. He ran over the history of the past year, in which from
day to day he had looked forward to this meeting; and he told with what joy
he had slowly added coin to coin, until he had saved a sufficient sum to
carry him home. Then, when he had finished, the sister and brother mingled
their thanksgivings and happiness together, and Christian’s heart swelled
full and overbrimming: she could have seated herself upon the floor, like
Ailie, and poured out her joy as artlessly. But it is Halbert’s turn now to ask
questions. When will little Mary be home? how long she stays. Halbert
wearies to see his little sister, but he is bidden remember that she is not little
now, and Christian sighs, and the dark cloud, that she fears is hanging over
Mary’s fate, throws somewhat of its premonitory gloom upon her heart and
face. Halbert, unnoticing this, is going about the room, almost like a boy,
looking lovingly at its well-remembered corners, and at the chairs and
tables, at the books, and last his eye falls on a card lying in a little basket,
and he starts as if he had encountered a serpent, and his eye flashes as he
suddenly cries out, almost sternly, as he lifts it and reads the name.
“Christian, what is this—what means this? Mr. Walter Forsyth a visitor
of yours; it cannot be. Tell me, Christian, what does it mean?”
“It is Mr. Forsyth’s card,” said Christian gravely; “an acquaintance, I am
afraid I must say a friend of ours. Indeed, Halbert, now that you are home
with us again, this is my only grief. I fear we shall have to give our little
Mary into his keeping, and he is not worthy of her.”
Halbert is calmed by his long trial, but his natural impetuosity is not
entirely overcome, and he starts up in sudden excitement and disorder.
“Walter Forsyth the husband of my sister Mary! Walter Forsyth, the infidel,
the profligate; better, Christian, better a thousand times, that we should lay
her head in the grave, great trial as that would be, and much agony as it
would cause us all, than permit her to unite herself with such a reptile.”
“Halbert,” said Christian, “the name misleads you; this cannot be the
man—the Forsyth who wrought you so much unhappiness and harm, and
has caused us all such great grief and sorrow; he must be much older, and
altogether a different person. This one is not even a scoffer, at least so far as
I have seen.”
“Christian,” cried Halbert vehemently, “I feel assured it is the same. Do
not tell me what he pretends to be, if he has any end to serve he can be
anything, and put on the seeming of an angel of light even. I tell you,
Christian, that I am sure, quite sure, that it is he. I met him as I came here,
and I shuddered as I saw him, and even felt myself shrinking back lest his
clothes should touch me; but little did I suspect that he was about to bring
more grief upon us. Does Mary, do you think, care for him?”
Christian could not but tell him her fears; but she said also that Mary had
always avoided speaking to her on the subject. What could they do? What
should be done to save Mary? Halbert, in his impatience, would have gone
to seek her out at once, and have pointed out to her the character of her
lover; but Christian only mournfully shook her head, such a plan was most
likely to do harm and not good.
“You must be calm, Halbert,” she said, “this impetuosity will be
injurious—we must save Mary by gentler means, she is far too like yourself
to be told in this outspoken manner—the shock would kill her.”
But old Ailie is stealing the door of the room open timidly, to break in on
the first hour of Christian’s joy, and when she entered she did it with a look
of sober cheerfulness, widely different from her late joyful frenzy.
“Miss Mary came in a while since,” she said, “and ran straight up to her
own room, without speaking, or waiting till I telled her of Mr. Halbert’s
home coming, and she looked pale and ill like; would you not go up, Miss
Christian, and see?”
The Melvilles are Ailie’s own children, and she has a mother’s care of
them in all their troubles, bodily or mental. So at her bidding Christian rose
and went softly to Mary’s room: the door was closed, but she opened it
gently, and standing hidden by the curtains of Mary’s bed, was witness to
the wild burst of passionate sorrow and disappointed affection in which
Mary’s breaking heart gushed forth, when she found herself once more
alone. Herself unseen, Christian saw the scalding tears welling out from her
gentle sister’s dim and swollen eyes, she saw the convulsive motions of her
lithe and graceful figure, as she rocked herself to and fro, as if to ease or
still the burning grief within: and she heard her broken murmurs.
“Had he but died before I knew this, I would have mourned for him all
my life, even as Christian mourns, but now—but now!—such as he is”—
and her burst of sobbing checked the voice of her sorrow. A moment after
she started up and dashed the tears from her eyes, with some vehemence.
“Should I not rather thank God that I have been saved from uniting myself
with a godless man—with my poor brother’s seducer?” and she sank on her
knees by the bedside. Poor Mary’s grief was too great for silent
supplications, and Christian stood entranced, as that prayer, broken by many
a gush of weeping, rose through the stillness of the quiet room. She had
never, she thought, heard such eloquence before of supplicating sorrow, had
never seen the omnipotence of truth and faith till then; gradually they
seemed to subdue and overcome the wildness of that first grief, gradually
attuned that sweet young sobbing, struggling voice, to sweetest resignation,
and ere Christian echoed the solemn “Amen,” Mary had given thanks for
her deliverance, though still natural tears, not to be repressed, broke in on
her thanksgiving, and silent weeping followed her ended prayer. But when
she bent her head upon her hands again, Christian’s kind arm was around
her, Christian’s tears were mingled with her own, Christian’s lips were
pressed to her wet cheek in tender sympathy, and the voice of Christian, like
a comforter, whispered,
“I know all, Mary, I know all; may God strengthen you, my dear sister—
you have done nobly, and as you should have done; may God bless you,
dearest Mary.”
And Mary’s head, as in her old childish sorrows, nestles on Christian’s
bosom, and Mary’s heart is relieved of half its heavy and bitter load. Poor
Mary! the days of childhood have indeed come back again, and, as the
violence of the struggle wears away, she weeps herself to sleep, for sorrow
has worn out the strength of her delicate frame, already exhausted by the
varied and contending emotions of the day, and now the tears slide slowly
from beneath her closed eyelids even in her sleep.
But Halbert is at the door anxiously begging for admittance, and
Christian leads him in to look at little Mary’s sleep. It was a child’s face, the
last time he looked upon it, a happy girlish face, where mirth and quick
intelligence rivalled each other in bringing out its expressive power; he sees
it now, a woman’s, worn with the first and sorest struggle that its loving
nature could sustain, and a kind of reverence mingled with his warm
affection as he bent over his sleeping sister; he had yielded to temptations,
oh, how much weaker, since his heart was not enlisted on the tempter’s
side; he had made shipwreck of his faith and of his peace, for years,
fascinated by attractions a thousand times less potent than those which this
girl, her slight figure still trembling with her late emotions, still weeping in
her sleep, had withstood and overcome; and Halbert bent his head, humility
mingling with his rejoicing. Had he only been as steadfast as Mary, how
much sorrow and suffering would they all have been saved.
They have left the room awhile with quiet footsteps, and there is much
gladness in those two hearts, though trembling still mingles with their joy;
for, if Christian fears the effect of this terrible shock on Mary’s health, at
least she is delivered; there is great happiness in that certainty, she has
found out Forsyth’s true character, though it passes all their guessing and
conjectures to tell how.
And now Halbert is asking about his father, and James and Robert, and
expressing his fears as to how they will receive him, the truant son. His
brothers will be rejoiced; but Christian shakes her head half doubtful, half
smiling, when Halbert, “and my father”—she cannot say, but an hour or two
more will bring that to the proof.
“Do you know, Christian, I feel myself like one of the broken men of the
old ballads, and I am in doubt, in perplexity, and fear, about this meeting.”
“If you are broken, if your ship has been cast ashore, we will get it
mended again,” said Christian, with more of humour and lightheartedness
than she had either felt or used for many a day. “But no more of that,
Halbert, just now. Tell me, will you go to see James to-night?”
“No, I can’t; it would be unseemly besides.”
Halbert will not leave his sister the first night of his return, and Christian
feels relieved; after a pause, he continues:
“How do you like Elizabeth now, Christian; are James and she happy
together?”
“I have no doubt they are,” said Christian, evasively; “why should they
not be?”
“But you don’t like her.”
“I never said so, Halbert.”
“Well, that’s true enough; but I inferred it.”
“Nay, you must make no inferences. Elizabeth can be very pleasant and
lovable; if she is not always so, it is but because she does not choose to
exercise her powers of pleasing.”
“So she can be lovable when she likes. But it was she, was it not, that
introduced Mary to Forsyth?” said Halbert, his brow darkening.
“You must forgive her that, Halbert; she was not aware of his character
when she received him as her cousin’s friend,” and Christian looked
distressed and uneasy, and continued; “and Halbert, you must not cherish a
vindictive feeling even against Forsyth, bad as he is, and great as is the
mischief he did you; promise me that, Halbert, promise me, now.”
“Well, I do promise you; I could not, if I would; and I now pity him
much more than hate him.”
They sat together conversing, till the shadows began to lengthen, when
Christian, compelled by domestic cares and preparations for the evening,
left her new found brother for a time.
CHAPTER IV.
Bear a lily in thy hand;

Gates of brass cannot withstand
One touch of that magic wand.
Bear through sorrow, wrong and ruth,

In thy heart the dew of youth,
On thy lips the smile of truth.—Longfellow.
HE day wore away, and now the evening darkened fast, and old
Ailie’s beaming face, illuminated by the lights she carries,
interrupts brother and sister, again seated in the cheerful fire-light,
which, ere the candles are set upon the table, has filled the room
with such a pleasant flickering half-gloom, half-radiance. And there, too, is
Mr. Melville’s knock, which never varies, at the door. Halbert knows it as
well as Christian, and grows pale and involuntarily glides into a corner—as
he had done of old when he had transgressed—but Christian has met her
father at the door, and whispered that there is a stranger newly arrived in the
room. It fortunately so happens to-night that Mr. Melville has come home
more complacent and willing to be pleased than he has done for many a
day. Some speculation suggested by James, and agreed to with sundry
prudent demurring by the heads of the house, has turned out most
successfully, and Mr. Melville has taken the credit of James’s foresight and
energy all to himself, and is marvellously pleased therewith. “A stranger,
aye, Christian, and who is this stranger?” he says most graciously, as he
divests himself of his outer wrappings; but Christian has no voice to answer
just then, and so he pushes open the half-shut door, and looks curiously
about the room; his son stands before him, his eyes cast down, his cheeks
flushed, his heart beating.
“Halbert!”
The human part of Mr. Melville’s nature melts for the moment, the
surprise is pleasurable; but he soon grows stern again.
“Where have you been, sir? what have you been doing? and why have
you never written to your sister?”
Halbert’s trial has taught him meekness, and his answers are in words
which turn away wrath, and his father turns round to seek his easy-chair on
the most sheltered and cosiest side of the glowing fire.
“Humph!” he says; “well, since you are home, I suppose it’s no use
making any more enquiries now, but what do you intend to do?”
Halbert looks astonished; it is a question he is not prepared to answer; he
feels that he ought not and cannot ask his father to enable him to carry out
the plan he has been dreaming of for the past twelve months, and he is
silent.
“There is plenty of time for answering that, father,” said Christian
briskly; “we can consult about that afterwards, when we have all recovered
ourselves a little from this surprise which Halbert has given us; and here
comes Robert.”
Robert came merrily into the room as Christian spoke, and not alone, he
had a companion with him whom he brought forward to introduce to
Christian, when his eye caught his brother. What! are we going to have old
Ailie’s extravagances over again. Poor Robert’s laugh is hysterical as he
tumbles over half a dozen chairs, and lays hold of Halbert, and his shout
electrifies the whole household, wakening poor sleeping Mary in her lonely
chamber. “Halbert! Halbert”—Robert is a fine fellow for all his
thoughtlessness, and is almost weeping over his recovered brother, and
Halbert’s newly acquired composure has forsaken him again, and he sobs
and grasps Robert’s hands, and thanks God in his heart. This is truly a
prodigal’s welcome, which Halbert feels he deserves not.
Robert’s companion hangs back bashfully, unwilling to break in upon,
lest he mar this scene of heartfelt family joy, which a good brother like
himself fully appreciates; but Christian’s kind and watchful eye is upon
him, and has marked him, and she comes forward to relieve him from the
awkward position in which he is placed, Marked him! yes, but what a
startled agitated look it is with which she regards him, and seems to peruse
every lineament of his countenance with eager earnestness. What can it be
that comes thus in the way of Christian’s considerate courtesy, and makes
her retire again and gaze and wonder? What a resemblance! and Christian’s
heart beats quick. But Robert has at length recollected himself, and now
brings the young man forward and introduces him as his friend Charles
Hamilton. Christian returns his greeting, but starts again and exchanges a
hurried glance with Halbert, who also looks wonderingly on the stranger.
Christian soon leaves the room, she has Mary to seek after, and attend to;
but as she passes Halbert’s chair, she bends over it and whispers in his ear,
and her voice trembles the while,—
“Is not the resemblance most striking—and the name?”
“It is most extraordinary,” answered Halbert aloud, gazing again on the
mild ingenuous face of the stranger. Christian glided away.
“What is most extraordinary, Halbert?” asked Robert, with a slight
impatience in his tone.
“Oh, nothing; at least only Mr. Hamilton’s great resemblance to an old
friend of ours long since dead.”
The young man looked towards him and smiled. Can that picture still be
hanging in its old place in Christian’s room?
Our poor Mary has slept long and calmly, and when Robert’s shout
awoke her, she started up in astonishment. She was lying in the dark room
alone, with silence round about her, and her pillow was wet with tears.
Mary raised herself in her bed, and throwing back the disordered hair which
hung about her face tried to collect her bewildered thoughts. The memory
of her grief has left her for the moment, and she is wondering what the
sound could be that came indistinctly to her ears; it sounded, she fancied,
very like “Halbert.” Who could be speaking of him, and as she repeats his
name the full knowledge of what has passed, all the momentous events and
misery of this day come upon her like a dream. Poor Mary! a heavy sigh
breaks from her parted lips, and she presses her hand over her painful eyes.
She does not see the approaching light which steals into the little room; she
does not hear the light footstep of its gentle bearer, but she feels the kind
pressure of Christian’s arm, and most readily and thankfully rests her head
on Christian’s supporting shoulder.
“I have news to tell you,” whispers Christian, “which you will be glad of
and smile at, though you are sighing now. You remember Halbert, Mary?”
Remember him! but Mary’s only answer is a sigh. Halbert’s name has
terrible associations for her to-night; she has remembered him and his
fortunes so well and clearly this day.
“Mary, Halbert has come home, will you rouse yourself to see him?”
“Come home, Halbert come home!” and the poor girl lifted up her head.
“Forgive me, Christian, forgive me, but I have done very wrong, and I am
very, very unhappy;” and the tears flowed on Christian’s neck again more
freely than before.
“You have done nobly, dear Mary—only rouse yourself, shake off this
grief; you have done well, and God will give you strength. Let me bathe
your temples—you will soon be better now,” said Christian, parting the
long dishevelled hair, and wiping away the still streaming tears. “That man
is not worthy one tear from you, Mary: be thankful rather, dearest, for your
deliverance from his cunning and his wiles.”
A deep blush flitted over Mary’s tear-stained face, as she raised herself
and began with Christian’s tender assistance to remove the traces of her
grief. Christian wondered as she saw her begin to move about the little
room again; there was a still composure gathering about her gentle features,
which the elder sister, accustomed to think of Mary as still little more than a
child, could only marvel at in silence. Her eyes were almost stern in their
calmness, and her voice was firmer than Christian could have believed
possible as she turned to speak.
“Yes, Christian, I am thankful—thankful beyond anything I can say; but
do not ask me about anything just now,” she continued, hurriedly, as
Christian looked up to her as if about to speak. “I will tell you all
afterwards, but not to-night—not to-night, dear Christian.”
“Would you not like to see Halbert, Mary?” said Christian, taking the
cold hands of her sister in her own. “Do you care or wish to see Halbert
now, Mary?”
“Yes, yes,” was the answer, and Mary’s eye assumed a kinder and more
natural glow. “I forgot, tell him to come here Christian, I would rather see
him, I cannot meet him down stairs.”
Halbert was speedily summoned, and when his step paused at the door,
Mary ran forward to meet him with pleasure in her eyes. True, Halbert’s
tone of affectionate sympathy brought the remembrance of that scene of the
morning, and with it the tears to Mary’s eyes; but Christian rejoiced to see
how gently they fell, and hoped that the sorest and bitterest part of the
struggle was past; and so it was, for Mary went down with untrembling step
and entered the room where her father, brother, and the stranger sat with a
sweet and settled calmness, which allayed all Christian’s fears.
It seemed now that however strange the stranger was to Christian, he
was no stranger to Mary Melville. Mr. Charles Hamilton was in truth well
known to Mary—yea, that Robert looked arch and intelligent, and his
young friend blushed as he rose to greet her on her entrance. This
acquaintanceship was soon explained, Mary had met him several times at
Mrs. James’s parties, and the casual mention which Robert and Mary had
made of him among the host of Elizabeth’s visitors had not been sufficiently
marked to attract the attention of Christian, engrossed as she was then with
such great anxiety regarding poor Mary’s unfortunate attachment.
Charles Hamilton’s qualities of head and heart were much too large for
Mrs. James Melville, and, accordingly, though she received him as a guest,
and was even glad to do so, from his social position and prospects—she
regarded him with much the same feeling which prompted her attacks on
Christian, and having noticed what poor Mary was too much occupied to
notice, the bashful attention with which the young man hovered about her
fair sister-in-law, Mrs. James had decided upon entirely crushing his hopes
by exhibiting to him this evening, at her party, the crowning triumph of her
friend Forsyth. Poor Mrs. James! how completely she had over-reached and
outwitted herself. That evening found her accomplished friend the rejected
—rejected with scorn and loathing, too—of simple Mary Melville, in no
humour for contributing to the amusement of her guests, and Charles
Hamilton in a far fairer way of success than even he himself had ever
dreamt of, for Christian’s eyes are bent on him from time to time, and there
is wonder blended with kindness in her frequent glances on his face, and
her pleasant voice has an unconscious tone of affection in it as she speaks to
him, as though she were addressing a younger brother. But the time has
come when they must prepare for Mrs. James’s party; Christian will not go,
Mary will not go, how could she? Halbert will not go, and the young
stranger’s face grows suddenly clouded, and he moves uneasily on his chair,
and at last rises reluctantly. Mr. Melville and Robert must go for a time at
least, to excuse the others that remain at home, and tell James of Halbert’s
return, and Charles Hamilton in vain hunts through every recess of his
inventive powers to find some reason that will excuse him for sitting down
again. But all fail, he can find nothing to offer as an excuse; he is intruding
on the family this night, sacred as it is—the evening of the wanderer’s
return—and when he may suppose they all so much desire to be alone; and
so he must take his leave, however loth and reluctant so to do. But while so
perplexed and disappointed Christian takes him aside, Christian bids him sit
down and speak to her a moment when Robert and his father have gone
away, and he does so gladly. Mary wonders what Christian can have to say
to him, a stranger to her till the last hour, and looks over, with interest every
moment increasing, towards the corner where they are seated side by side,
and so does Halbert too; but there is no astonishment in his face, though
there is compassionate affection beaming from his eyes. Their conversation
seems to be most interesting to both, and the look of sad recollection on
Christian’s gentle face seems to have been communicated to the more
animated features of her companion, and at length he suddenly starts and
clasps her hand.
“Christian Melville!” he exclaims, “Oh that my mother were here!”
The tears stand in Christian’s eyes—some chord of old recollection has
been touched more powerfully than usual, and Christian’s cheeks are wet,
and her eyes cast down for a moment. Mary can only gaze in astonishment,
and before she recovers herself Christian has led the young man forward to
them, and then she hurries from the room, while Halbert extends his hand to
him cordially. What is the meaning of this? both the young men join in
explanations, but Charles Hamilton’s voice is broken, half with the
recollection of his dead brother, and half with the pleasure of discovering
such a tie already existing with Mary’s family. Yes, Charles’s brother was
the original of that saint-like portrait which hangs within reach of the
glories of sunset on the wall of Christian’s room. The grave where Christian
had buried her youthful hopes was the grave of William Hamilton, and that
one name made the young man kindred to them all; and when Christian
after a time came down stairs again, she found him seated between Halbert
and Mary as though he had been familiar with that fireside circle all his
days, and was indeed a brother.
It was a happy night that to the group in this bright room, a night of great
cheerfulness and pleasant communion, just heightened by the saddening
tinge which memory gave it, and Mary, our sweet Mary, marvels at herself,
and is half disappointed that there is so little of romance in the fading of her
sorrow; but marvel as she likes, the unwitting smile plays on her lips again,
and you could scarce believe that those clear eyes have shed so many tears
to-day. She feels easier and happier even, now the weight of concealment,
which disturbed and distressed her in Christian’s presence of late, is
removed from the spirit; and she is the same open, single-minded,
ingenuous girl as heretofore; the secret consciousness that it was not right to
yield to Forsyth’s fascinating powers is gone now, and Mary Melville is
herself once more, aye, more herself than she has been for months past,
notwithstanding the bitter suffering of that very day. God has graciously
tempered the fierceness of his wind to the tender and trembling lamb, and
Christian’s confidence is restored, and she feels sure that time will make
Mary’s heart as light as ever, and efface from her memory the image of that
evil man, and blot out the traces of this day’s agony; and a smile flits over
Christian’s cheerful face as she fancies the substitution of another image in
the precious entablature of Mary’s heart. Who can tell but Charles Hamilton
may gain a right to the name of brother, which she already hesitates not to
accord, better than his present claim, precious to her mind as it is.
Mrs. James Melville’s party is sadly shorn of its lustre this year, when
we compare it with its last predecessor, only a short twelvemonth since; and
already, in spite of all the attractions of gossip, music, and flirtation, her
guests are beginning to yawn and look weary. Mrs. James was never so
annoyed in her life, all seems this night to have gone wrong. Her very
husband had deserted her—she had seen him fly down stairs three steps at a
time, and skim away through the cold street towards his father’s house.
Mrs. James was enraged to be left alone at such a time for any Halbert of
them all.
“A nice fuss was made about him, as much nonsense when he went
away as if there wasn’t another in the whole country, and now when he
thought fit and had come home——”
Mrs. James could not finish the sentence, for spite and vexation
overmastered her. Forsyth was not there, her chief attraction; Mary was not
there, and even Christian’s absence, little as she liked her, was another
source of annoyance; and this flying off of James was the finishing stroke.
We hardly think, however, that even Mrs. James would not have melted had
she seen her husband in the middle of yon cheerful group, with his beaming
joyous face, shaking Halbert’s hands over and over again, to the imminent
danger of bone and joint. We really think she could not but have helped
him.
There was a voice of thanksgiving in Mr. Melville’s house that night, of
thanksgiving which told in its earnest acknowledgment of many mercies;
thanksgiving whose voice was broken by the sobbings of one and
accompanied by the happy tears of all, for Halbert led their devotions, and
when his earnest tones rose up among them there was not a dry cheek in the
kneeling family, not James, though it might be thought his heart was
alienated from the overflowing affection of home, by the remembrance of
his own; not Charles Hamilton, permitted, nay requested, to stay, for who so
well as Halbert could give thanks for that double deliverance.
There are dreams to-night hovering with drowsy wing about the
dwelling, dreams which alight on Charles Hamilton’s young head as he
hastens home, his heart full of the last scene of the evening, and his voice
repeating—
“In dwellings of the righteous

Is heard the melody
Of joy and health: the Lord’s right hand
Doth ever valiantly;”—
dreams which enter Halbert Melville’s long shut chamber, welcoming its
old dreamer back again—dreams which float about Christian’s resting-place
—above the fair head laid on Christian’s shoulder, calm as in the happy
days of childhood; sweet, hopeful, cheering dreams, that open up long
vistas of indistinct and dazzling brightness, all the brighter for their glad
uncertainty before their eyes, and fill the hearts which tremble in their joy
with a sweet assurance that calms their fears into peace. Even Ailie
dreamed, and her visions were of a gay complexion, fitting the nature of her
doings through this eventful day, and had various anticipations of bridal
finery floating through them. Nay, the very wind which whistled past Mr.
Melville’s roof-tree had a language of its own, and admirable gleesome
chuckle, which said plain as words could speak that happy as this night had
been beneath it, there would be merrier, happier doings here next new
year’s day.
CHRISTIAN MELVILLE.
EPOCH V.
Sweet is the sunshine lacing with its light,

The parting storm-cloud after day of sadness;
That ere the even darkens into night
O’erflows the world with glory and with gladness;
But sweeter is the flood of pleasantness,
That breaks at noonday through the clouds of morning,
While yet the long glad hours have power to bless,
And the earth brightens ’neath its warm adorning
Of scattered sunbeams. So their fate excels
In blessedness, upon whose noonday story
The heavenly sunshine of God’s favour dwells,
While yet their tongues are strong to speak His glory;
And blessed they, O Lord! who, saved and free,
Stretch out compassionate hands to draw men near to thee!
CHAPTER I.
They thicken on our path,
These silent witness years;
A solemn tenantry, that still land hath
Wherein were spent our bygone smiles and tears;
Graven on their secret tablets silently,
Stand deed, and thought, and word,
Beyond the touch of change or soft decay,
’Stablished perpetually before the Lord!
* * * * *
Season of labour, time of hope and fear,
Kind to our households let thy varyings be;
With thee we give a sigh to the Old year,
And do rejoice us in the New with thee.—Y.S.P.
EN years have passed away, and again it is a fireside scene that

we have to depict, and a fireside conversation we have to
chronicle. The room we now stand in is large and pleasant, and
bright with the radiance of merry faces—faces of every age and
size, but all marvellously alike in features, as in happiness, from the grave
seniors down to the crowing baby, through all the gradations of stature and
sobriety that crowd around that well-spread table. The assembly is too
large, and the children too near each other in age to allow you to think them
all members of one household; and two fathers half checked, half
encouraged the merry crowd, and two mothers took sweet counsel together,
praising each other’s little ones, and exchanging domestic experiences with
each other. We must try and find in these merry faces the traits of those we
have known before. Let us see whom we have before us. A man of goodly
presence is the elder; grave, it seems, habitually, but with a smile that is like
a sunbeam, and which has an electrical effect in the saddest house it beams
in; and many, many houses of sorrow does it see, and many mourners are
cheered by the words of hope and comfort that flow from these
sympathising lips; for you will see, if you look at his apparel, and mark his
manner, that he holds a high vocation, no less than a labourer about that
glorious vine which has the Eternal Father for its husbandman; a labourer,
one who, like the bee, seeks honey from every flower, and from his pulpit,
and standing by beds of suffering, and in the dark, close, and fœtid haunts
of sin, seeks to have souls for his hire as the labour of his life and the joy of
his existence. No mere Sabbath day worker in his pulpit, but one that never
tires, that is always ready, and almost always with his harness on his back;
like a good knight of the olden time, prompt to succour the distressed. The
lady too, who sits beside him, has about her a gentle dignity that is akin to
his; but with her blooming cheek and bright eye we can boast no old
acquaintance, though when she lays her white hand on his arm and calls
him “Halbert,” we are half ashamed to say so much of Halbert Melville’s
wife.
But on the other side of the fire sits a younger lady, with a calm air of
matronly self-possession, which almost sets our memory at defiance; it is
true that her face looks so youthful in its eloquent expressiveness that, but
for that copy of it that shines at her knee, through the fair straggling locks
of a little merry girl, you might fancy her still the Mary of ten years ago; but
in the silent depths of her dark eyes sits such serene and assured happiness,
at once so calm, and deep, and full, as makes one sure this cannot be the
disconsolate inhabitant of yon dim chamber, weeping in her sleep in the
first agony of womanly woe. Yet so it is, and lightly have these ten swift
years—long, oh, how long and dreary to many—flown over her, effacing so
entirely everything but the remembrance of those passages in her history
from her mind, that when she looks back now upon that troubled time, she
half smiles, half blushes for her old self, and reckons of her brief but
agonising trial, as sick men recall to their memories the terrible dreams of
some delirious fever fit. For Mary Melville has found entire and perfect
kindred in the heart of one whom then she little recked of and cared not for,
and she wonders now how she, ever the object of Charles Hamilton’s warm
and full affection, could have overlooked his nobler qualities, and preferred
instead Forsyth’s deceptive and hollow brilliancy, and the glitter of well-
displayed accomplishments, which threw the blushing youth into the shade.
And the blushing youth of our last chapter blushes no longer when he
speaks to Mary, nor has his bashfulness been seen, Halbert says, for nine
long years and more; never since one bright autumn evening, when Mary
and he surprised Christian in her solitude by the whispered communication
of an important agreement come to between them, and which was carried
into effect, ratified and sealed, on the following new year’s day, fulfilling,
in the most joyous manner, old Ailie’s dream. At this transaction Halbert’s
presence was indispensable, albeit he was again, after Christian’s kind
persuasions and James’s spirited remonstrances had shamed their father into
liberality, finishing the long forsaken studies so disastrously interrupted of
old, with a vigour and ardour that was unquenchable. True, he did not come
to James’s wedding when it took place; but Christian, and Mary, and
Charles Hamilton were each and all immovable in their demands; they
could not do without Halbert, and so he was present at the ceremony,
exciting Charles’s wrathful contradiction, and Christian and Mary’s
curiosity, by hinting merrily of another Mary, whose presence would throw
the bride of to-day into the shade, though no one at that blithe bridal looked
on Mary Melville with more affectionate admiration than her brother
Halbert. And lo! when the time of Halbert’s study and probations was over,
and Providence had so ordered that the place of his ministry should be the
same as that of his birth, and the dwelling-place still of his nearest and
dearest kindred, then came about another bridal, and the name of Mary
Melville was resuscitated, though Mrs. Charles Hamilton’s proud husband
would never allow that the old bearer of the name was equalled by the new.
But there is no rivalship between the sisters—sisters in affection as much
as in name—and the children, whose fair heads have sprung up like flowers
beside and about them, are like one family in their cordial intercourse. But
where is Christian? Our enquiry is echoed by half-a-dozen merry voices.
“Where can Aunt Christian be?” There will be no need to ask the question a
moment hence, if indeed we can discern our old friend through the pyramid
of children that are clustering about her; the little girl that stood by Mary’s
knee has left for Aunt Christian, and now stands on a chair beside her, with
her round arms about her neck, and her rosy face beaming on her shoulders;
the sturdy boy who leant on Halbert’s chair has left that place of honour for
Aunt Christian, and he stands proudly at her right hand as prime minister,
helping at the distribution of the great basketful of new year’s dainties—for
this is again the first night of another year—which she has brought to
gladden these youthful hearts. The whole host of her nephews and nieces,
absorbed a moment since in their various amusements, have left them all for
Aunt Christian, and are gathered about her, one clinging round her waist
and one hanging at either arm, greatly impeding the action of her gift-
dispensing hand. Sure enough here is Christian, how blithe! how happy!
Time has dealt gently with her, and though he has drawn a thread of silver
through the rich dark abundance of her plainly braided hair, there is not one
in this room that would not start up in indignant surprise, if you said that
Christian was either looking or growing old.
“Nay, nay,” said Halbert, not long ago, when some indifferent friend of
the family suggested this, “Christian will never grow old. When years come
upon her, she will glide away like a streamlet into a river, but she will not
fade. Christian’s spirit will always be young.”
And so it is; her soft clear voice stills all that little childish hubbub in a
moment. The very baby stays its scream of joy, as if it too would listen to
Aunt Christian, and little Mary on her shoulder, and strong Halbert at her
right hand, and every separate individual of their respective hosts of
brothers and sisters would dare in single-handed valour any full-grown
Goliath that would presume to interrupt the expression of Aunt Christian’s
pleasure, pleasant as it always is. It is a great day this, with these two united
families. A day of childish jubilee to the younger members, and of joyful
commemoration to the older, for Halbert looks back with glistening eyes,
and rejoices in the union of ten years ago, a beginning of happy, laborious
years to him; and Mary remembers her early trial, and thanks God most
earnestly for deliverance, and participates with her husband in the happier
recollections of their marriage day; and the other Mary, with generous
affection, sympathises with each and all; and Christian? Christian’s heart,
open at all times to generous impulses, seems to have its sluices of
overpouring and constant love thrown wide open for the free passage of its
swelling tides, each new year’s night, and if you heard her fervent
thanksgiving when she kneels before God alone, you would think that flood
of blessings had been all poured out upon her, not that its fulness had
flowed upon her friends, but that she herself was the individual recipient of
every separate gift. For Christian identifies herself with those dear ones so
entirely, that she looks upon their happiness as a peculiar blessing bestowed
upon herself. Christian has, however, now seated herself in the empty chair
waiting for her—jealously kept for her, indeed—at the brightest corner of
the cheerful fireside, and taking a little namesake of her own, a grave,
serious, thoughtful child, who has begun to lisp wisdom already with her
infant tongue, upon her knee, she joins in the conversation which her
entrance, and still more her equitable distribution of the basket of good
things had interrupted.
“Father,” questioned Halbert Melville, second bearer of the name, “do
you keep new year’s day because it is new year’s day?”
“Why do you ask, Halbert?” said his mother, smiling, as she drew the
boy towards her.
“Because, Mamma, nobody else cares about it here; and I’ve heard Aunt
Christian say how foolish it was for people to keep their birthdays, as if
they were glad that time was going away from them, people that don’t use
their time well either,” moralised Halbert, looking earnestly in his mother’s
face, “and isn’t new year’s day just the same as a birthday and—” the boy
hesitated and seemed unwilling or unable to say more.
“And what, Halbert,” said Christian, as the boy paused and looked down,
“and what—what was it you were going to say?”
“I don’t know, Aunt Christian,” hesitated Halbert, “I don’t know whether
it’s right or not, but shouldn’t we be rather sorry when the new year comes,
than glad that the old year has ended?”
“And why sorry, Halbert?” said his father, who had hitherto been
listening in silence, “why do you think we should be sorry?”
“Because, father,” said Halbert, quickly, raising his eyes, “because you
said in your sermon last Sabbath, that when once a year was gone, if we had
not spent it well, it was entirely lost for ever, for we could never bring a
minute back again.”
“And therefore you think we should be sorry, do you, Halbert?” rejoined
his father.
“Yes, father,” was the answer, and again young Halbert’s face was cast
down, “for you say often that nobody spends their time well, or as right as
they should do.”
The elder Halbert did not answer, but he took little Christian, who had
been gazing with her large eloquent eyes at every one that spoke in turn,
and had attended diligently and earnestly to the unusual conversation, upon
her aunt’s knees. “Well, little one, do you think we should be sorry when
the new year comes?”
“I think we should be both sorry and glad, papa,” was the prompt
answer.
“Well, Christian, Halbert has told us why we should be sorry; now do
you tell us what it is we should be glad for.”
There was a murmur among a little knot at a corner of the table, and a
half-suppressed laugh before Christian had time to answer her father’s
question.
“Who is that? what is it that makes you so merry?” said Halbert, smiling
and shaking his head at the merry urchins, who were congregated in a
group.
“It’s only our Halbert, uncle, it’s only our Halbert,” whispered little
Mary Hamilton, deprecatingly.
“Well, Mary, we are impartial to-night, so we must hear what our
Halbert has to say; come here, sir.”
And Halbert Hamilton, the wildest little rogue that ever kept nursery in
an uproar, or overcame nurse’s patience, or conquered her heart by his feats
of merry mischief, half hid himself below the table in pretended fear and
dismay at his uncle’s summons, and did not stir.
“Come, Halbert,” said Mary, his mother, as Charles drew his incorrigible
son into the middle of the little circle, “what did you say over there?”
Halbert the third looked down and blushed, and then laughed outright.
“He only said we should be glad when the new year comes, because we
have plenty of fun,” interposed Mary Melville, her wild cousin’s constant
defender and apologist.
“Quite right, my boy,” said the elder Halbert, laying his hand kindly on
the boy’s head, “the coming of plenty of fun is a very good and proper thing
to be glad for; but sit you down now, and let us hear what little Christian
has to say.” And Halbert sat down at his uncle’s feet to listen.
“Well now, Christian, what should we be glad for? Is it because there is
plenty of fun, as Halbert says?”
“No, papa,” said the little, grave girl, seriously, shaking her head
solemnly, “no, it is not that. I think it’s because we have another to be good
and do right in. Isn’t that it, Aunt Christian?”
And the little girl looked over to her aunt inquiringly, to see if her
childish conclusion was a correct one.
“Just so, my dear,” was Aunt Christian’s answer, as Halbert patted the
child’s soft cheek, and then permitted her to make her way over to her
accustomed seat.
The children were gathered now about their parents’ knees, and even
wild Halbert Hamilton was silent and attentive. “Yes, children,” said the
kind father and uncle, as he looked round upon them, “yes, children, there is
a better reason for being glad than even having plenty of fun. There is a new

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“Into the blithe and breathing air,

“Before me rose an avenue

“And falling on my weary brain,

Bear a lily in thy hand;

Bear through sorrow, wrong and ruth,

“In dwellings of the righteous

Sweet is the sunshine lacing with its light,

EN years have passed away, and again it is a fireside scene that

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