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OBJ: Cognitive Level: Comprehension
2
4. The children who are at greatest risk of infant death are born:
a. to mothers under age 18 c. to fathers and mothers over age 40
b. into families in poverty d. into families with alcohol problems
ANS: B
Feedback
A Incorrect: Birth weight is the major determinant of infant mortality rate (IMR).The lower
the birth rate, the higher the mortality. Adolescent pregnancy is associated with low birth
weight which contributes to infant mortality, but it is not the major factor.
B Correct: Racial disparities exist for infant mortality. The IMR for African Americans is
twice the rate for whites because of the high rate of low birth weight infants born to
minority mothers. Poverty is the most important factor in determining IMR. More
nonwhites than whites are poor in the United States. Women who live in poverty are
unlikely to be in good health or to have access to prenatal care which are vital during
pregnancy.
C Incorrect: Infant mortality rate is higher for mothers over the age of 40. However, this
does not apply to fathers.
D Incorrect: Although substance abuse such as alcohol does affect birth outcomes, it is not
the greatest risk factor of infant death.
PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Application
5. The chance that a child will have to repeat a grade in school or be placed in special education classes:
a. is the same for the general population, regardless of circumstances
b. depends mainly on the quality of the schools and the teachers
c. increases a small amount for each year the child lives in poverty
d. depends mainly on whether the child has moved during the school year
ANS: C
Feedback
A Incorrect: School achievement declines with the time a child spends in poverty, thus
increasing the possibility of having to repeat a grade or be placed in special education
classes. A child living in poverty does not have the same chance of succeeding in school
as a child in the general population.
B Incorrect: Poor quality of schools and teachers may adversely affect a child’s
performance in school; however, it is not the major predictor of a child having to repeat a
grade or be placed in special education.
C Correct: The chance a child will be retained in a grade or be placed in special education
increses 2% to 3% for every year that the child lives in poverty.
D Incorrect: Moving during the school year may affect a child’s performance in school, but
it is not the most significant factor.
PTS: 1 REF: p. 6 - Poverty

6. The fastest-growing segment of the homeless population consists of which of the following groups?
a. alcoholics refusing treatment c. single males
b. mentally ill people d. families with children
ANS: D
Feedback
A Incorrect: Many individuals become homeless because of substnace abuse, but they are
not the fastest growing segment of the homeless population.
B Incorrect: Mental illness is one reason for homelesssness, but mentally ill people are not
the fastest growing segment of the homeless population.
C Incorrect: In the past the homeless population primarily consisted of single males;
however, this is not true today.
D Correct: Currently the fastest growing segment of the homeless consist of families with
children, most commonly single mothers with two or three children.
PTS: 1 REF: p. 7 - Homelessness

3
7. Which of the following groups of people disproportionately represents the homeless population?
a. African Americans c. Hispanics
b. Caucasians d. Asians
ANS: A
Feedback
A Correct: The homeless population is disproportionately represented by African
Americans. Chronic and peristant multigenerational poverty is the primary driving force
resulting in this group’s homelessness.
B Incorrect: Caucasian’s poverty rate is the lowest among these racial and ethnic groups.
C Incorrect: Hispanics poverty rate at 21.5% as compared to 25.3% to the African
American group is the second most likely racial/ethnic group to be affected by
homelessness.
D Incorrect: Asian population like the Caucasian population is 50% or more lesss likely to
be entrapped in a chronic, persistent cycle of poverty.

8. A teacher confers with the school psychologist and the school nurse about a child who has poor attention span, aggresseivbehaviors, delayed
speech, and shyness, and who tends to withdraw. This child often falls asleep in class, saying he is not sleeping at nhigt. Which of the following
situations or conditions is most likely to cause or contribute to the behavior exhibited by this child?
a. sharing a room with a sibling
b. attention deficit disorder with hyperactivity
c. homelessness
d. narcolepsy
ANS: C
Feedback
A Incorrect: Sharing a room with a sibling might result in sleep problems but none of the
other behaviors.
B Incorrect: ADHD is a physical disorder which may result in the poor attention span and
aggression but none of the other behaviors.
C Correct: A homeless child is a child experiencing traumatic insecurity and will exhibit al l
cited behaviors and more.
D Incorrect: Narcolepsy is a physical disorder causing a child to fall asleep at any time but
should not contribute to the other behaviors cited in the situation.

9. Psychological problems most often identified among homeless children are:

a. conduct disorder
b. oppositional defiant disorder
c. depression, anxiety, and behavioral problems
d. personality problems and difficulty with authority figures
ANS: C
Feedback
A Incorrect: Conduct disorder is a psychological disorder characterized by irresponsible,
delinquent behaviors such as truancy and running away; violations of the rights of others,
and overt physical aggression. Conduct disorder is acting out behavior; whereas,
depressed and anxious individuals (homeless children) do not tend to display antisocial
behavior.
B Incorrect: Oppositional defiant disorder (ODD) is characterized by hostile, negativistic,
defiant, and disobedient attitudes and behaviors, especially toward authority figures.
C Correct: Psychological problems identified most often among homelesss children includ e
anxiety, depresssion, poor attention span, trouble sleeping, delayed speech, shyness,
withdrawl, and aggressive behaviors.
D Incorrect: Personality problems are manifested in behavior that deviates markedly from
the expectations of one’s culture. Difficulty with authority figures is a symptom of ODD.

4
10. Because of their age, children are most likely to gain access to a firearm in:
a. the home or the home of a friend or relativ
b. a pawn shop
c. a local gun dealer or a gun and knife show
d. a sports store
ANS: A
Feedback
A Correct: The presence of a gun in the home increases the risk of homicide, suicide, and
accidental shootings. The majority of firearms used in these incidents are stored in the
home of the victim or in the home of a relative or friend.
B Incorrect: Natural barriers would preclude a children or adolescent from obtaining a
firearm from a pawn shop.
C Incorrect: Natural and legal barriers would preclude a children or adolescent from
obtaining a firearm from a local gun dealer or a gun and knife show.
D Incorrect: Natural and legal barriers would preclude a children or adolescent from
obtaining a firearm from a sports store.
PTS: 1 REF: p. 11 - Violence

11. The infant mortality rate (IMR) is the number of infant deaths:
a. during the first month of life for a given country
b. during the first year of life per 1,000 live births
c. compared to live births in a given location
d. from natural causes in the first year of life per 100 births
ANS: B
Feedback
A Incorrect: The first month of life is automatically included in the first year of life, but the
statistic is not kept separately by most nations.
B Correct: The international health care community has determined to keep a statistic
which includes all live births that die within the first year per 1,000 live births. The
statistics are self reported by nation states.
C Incorrect: The statistic reports the number of infant deaths per 1,000 live births by
location/nation/state.
D Incorrect: The statistic reports deaths from all causes in the first year of like per 1,000
live births.
PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge
12. Which of the following racial groups has the highest infant mortality rate?
a. Caucasians c. American Indians
b. Asians d. African Americans
ANS: D
Feedback
A Incorrect: Caucasians experience the lowest infant mortality rate (IMR).
B Incorrect: Asians IMR is less than African Americans.
C Incorrect: American Indians IMR is less than African Americans.
D Correct: The IMR for African Americans is twice the rate for Caucasians.
PTS: 1 REF: p. 13 - Cultural Considerations box OBJ: Cognitive Level: Knowledge
13. The United States has which of the following ranks among the developed nations that have the lowest infant mortality erast(IMRs)?
a. 1 c. 23
b. 17 d. 30
ANS: D
Feedback
A Incorrect: The United States ranks 30th in the statistical rankings reported in 2008.
B Incorrect: Seventeenth is better than 30th, but also incorrect.
C Incorrect: Twenty third is better than 30th, but also incorrect.
D Correct: The United States ranks 30th in the statistical rankings reported in 2008.
PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge
5
14. At the beginning of the 20th century, the major cause of child mortality for children aged 1 to 19 was:
a. farm accidents c. infectious disease
b. firearms d. industrial accidents
ANS: C
Feedback
A Incorrect: America has become increasingly urbanized over the 20th century with only a
fraction of children being raised on a farm.
B Incorrect: City life has reduced children’s exposure to firearms as compared to living on
the farm.
C Correct: At the beginning of the 20th century, people moved from the farms into the
cities. As a result we live in closer and more crowded quarters, providing easy
transmission for infectious diseases.
D Incorrect: Child labor laws were enacted and enforced in the late 19th century.
PTS: 1 REF: p. 12 - Child Mortality

15. Today, which of the following causes of death accounts for the majority of deaths in children ages 1 to 19?
a. unintentional injuries c. suicide
b. homicide d. respiratory illnesses
ANS: A
Feedback
A Correct: Deaths from all diseases among children ages 1 to 19 are dwarfed by the
number of children who die from unintentional injuries. A nurse must conclude that som e
of these deaths from unintentional injuries may be preventable.
B Incorrect: Homicide affects a minor portion of deaths among children ages 1 to 19.
C Incorrect: Although suicide is more common among adolescents, it still represents a smal l
fraction of deaths in this age group.
D Incorrect: Respiratory illnesses represent a minor cause of death in this age group.
PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge
16. For children under 1 year of age, what is the leading cause of unintentional injury-related deaths?
a. motor vehicle occupant injury c. drowning
b. suffocation d. fires
ANS: B
Feedback
A Incorrect: The laws require children to be secured in child safety seats, and the number o f
motor vehicle injuries among this age group has declined.
B Correct: Typical causes of suffocation include choking on food or objects and
entrapment of their head and neck in cribs or bedding.
C Incorrect: Parents rarely leave children under the age of 1 unattended around or in water.
D Incorrect: Fire codes and their enforcement has caused a dramatic decrease in deaths in
children under the age of 1.
17. The leading causes of injury-related death for children aged 1 to 4 years is:
a. choking and drowning
b. fires and burns
c. fires and neglect
d. drowning and motor vehicle occupant injury
ANS: D
Feedback
A Incorrect: Choking is the leading cause of injury-related death in children under the age o f
1; drowning is a leading cause of death over the age of 1.
B Incorrect: Fires and burns follow injury-related deaths by motor vehicle accident and
deaths by drowning.
C Incorrect: Fires follow deaths by motor vehicle accident and deaths by drowning. Neglec t
can lead to death or injury by several means.
D Correct: As toddlers and young children become more mobile, they fall into swimming
pools, lakes, and creeks as a result of poor adult supervision. Deaths for children from
motor vehicle injuries is the greatest between the ages of 5 to 14.
6
18. The leading cause of injury-related deaths in adolescents aged 14 to 19 is by:
a. drowning c. suicide
b. motor vehicle occupant injuries d. homicide
ANS: B
Feedback
A Incorrect. Adolescents are far less likely to drown than younger children.
B Correct. Adolescent inexperience driving and other risky behaviors take a heavy toll, as
motor vehicle occupant injuries become the number one cause of unintentional injury
deaths from age 14 to 19.
C Incorrect. Although suicide becomes more prevalent in this age grouping, it remains a
smaller percentage cause for death.
D Incorrect. Although homicide becomes a larger percentage cause for injury-related death s
among this age group, it remains dramatically overshadowed by motor vehicle occupant
injuries.
19. In the United States, which of the following occupations is the most hazardous?
a. agriculture c. construction
b. mining d. medical
ANS: A
Feedback
A Correct. Farming and ranching remains a major family enterprise in America, and
represents the most hazardous occupation. Heavy machinery, livestock, physical labor
involving heavy lifting, pesticide and herbicide exposure, exposure to viral, bacterial and
fungal infections are on the short list of hazards. Children are more vulnerable to all thes e
risks than are adults.
B Incorrect. Agriculture surpassess mining and construction as the most hazardous
occupation in the United States.
C Incorrect. Agriculture as more hazardous than construction in the United States.
D Incorrect. Medical occupations are among the safest in the United States.
PTS: 1 REF: p. 9 - Migrant Farm Workers OBJ: Cognitive Level: Knowledge
20. In 1987, the Association for the Care of Children's Health (ACCH) stated that paramount in the concept of family-centedrecare is meeting the
ever-changing needs of:
a. the individual child c. the community
b. all family members d. the society
ANS: B
Feedback
A Incorrect. Family-centered care describes a philosophy of care that recognizes the
centrality of the family in the child’s life, the family in its entirety, not the individual
members.
B Correct. Meeting the ever-changing needs ofall family members, not just those of the
child, is paramount to the concept of family-centered care.
C Incorrect. The community is a support to the family, and is not critical to the concept of
family-centered care.
D Incorrect. The society is the broader context to which the family belongs, but it is not
paramount to the concept of family-centered care.
PTS: 1 REF: p. 15 - Family-Centered Care

21. One of the eight key elements of family-centered care states that the constant in a child's life is the:
a. church c. neighborhood
b. school d. family
ANS: D
.
Feedback
A Incorrect. The more central constant in any child’s life using family-centered care is the
family, not the church.
B Incorrect. The most central constant in any child’s life using family-centered care is the
family, not the school.
C Incorrect. The most central constant in any child’s life using family-centered care is the
family, not the neighborhood.
D Correct. Family-centered care assumes the first constant in a child’s life is the family.
PTS: 1 REF: p. 16 - Box 1-3

7
22. Which of the following describes the exchange of information between families and professionals in family-centered care?
a. Only medical information needs to be exchanged between professionals and the famil
when necessary.
b. Complete and unbiased information must be exchanged between professionals and family
in a supportive manner at all times.
c. The family will decide what information they are comfortable with giving the
professionals.
d. Professionals will set the parameters for information in the first interview with the family
and will contact the family for information as needed.
ANS: B
Feedback
A Incorrect. In family-centered care, a central tenet is the promotion of greater family
self-determination, decision-making capabilities, control and self-efficacy. The
information exchange must be unguarded and complete between healthcare providers an d
the family members.
B Correct. Exchanging complete and unbiased information in a supportive manner at all
times between the family members and the healthcare professionals is required.
C Incorrect. The family must exchange complete and unbiased information in a timely
manner to the healthcare professionals, or the care provided will be compromised.
D Incorrect. Family-centered care is a process, with a beginning and an end, but
information exchange must be ongoing, complete and unbiased.

23. The medical model directs health care professionals to follow the roles of:
a. advocate and advisor c. evaluator and controller
b. teacher and director d. manager and mentor
ANS: C
Feedback
A Incorrect. The medical model directs health care professionals to assume the roles of
evaluator and controller of treatment interventions. This role is in conflict with advocate
and advisor.
B Incorrect. The medical model directs health care professionals to assume the roles of
evaluator and controller of treatment interventions.
C Correct. The medical model directs health care professionals to assume the roles of
evaluator and controller of treatment interventions.
D Incorrect. The medical model directs health care professionals to assume the roles of
evaluator and controller of treatment interventions. This position is in direct conflict with
conditions necessary for more active involvement of caregivers in the child’s care.
PTS: 1 REF: p. 1 - Family-Centered Care OBJ: Cognitive Level: Knowledge
24. To empower caregivers of children to make decisions about their child's care, the health care provider most needs to:
a. assess family decision making in the past
b. provide needed education and knowledge for the family
c. tell the family they are in charge of decisions
d. initially make difficult decisions and let the family make easier ones
ANS: B
Feedback
A Incorrect. Assessing previous or past family decision making may determine the
effectiveness of the family in making choices, but it cannot inform them about choices
they may face now or in the future.
B Correct. For a family or caregivers to be informed about decisions they face currently
about their child’s care, they must be informed and educated about the choices and the
projected outcomes.
C Incorrect. Being in charge of decisions without knowing the options and choices does not
inform the caregivers, only gives them the accountability.
D Incorrect. Empowering caregivers to make decisions includes all choices, both difficult
and easy.
PTS: 1 REF: p. 17 - Advocate

8
25. Placing no limits on the ages or numbers of visitors and providing sleeping facilities for the caregivers in a child'osorm in a health care facility
will most likely bring which of the following results?
a. The child will be more dependent on the family
b. There will be loss of rest by the child.
c. Family-centered care will be enhanced.
d. Nurses will find procedures less difficult to carry out.
ANS: C
Feedback
A Incorrect. A central concept of family-centered care is to allow the family to be more in
control of who can come and go, who can stay, making the child less dependent on the
family, as friends and neighbors can be more involved.
B Incorrect. Loss of rest by the child is not a reason to restrict who can come and go and
who can stay.
C Correct. Other strategies that enhance family-centered care include no limits on the ages
or number of visitors (unless directed otherwise by the family), and adequate sleeping
facilities for the caregivers in the child’s room.
D Incorrect. In fact, nurses may find procedures are more difficult to carry out with family
and friends in the room.

26. Professional pediatric nurses practice in a wide variety of settings. In each setting the primary roles of the pediatrincurse will:
a. be universal or be the same c. be slightly similar
b. vary slightly d. vary widely
ANS: A
Feedback
A Correct. Although each setting may have separate roles and responsibilities, the roles
that nurses take are universal.
B Incorrect. The primary roles of the professional pediatric nurse are universal, and include
the primary roles of caregiver, advocate, educator, researcher, manager, or leader. These
do not change.
C Incorrect. Similar is not the same.
D Incorrect. The primary roles do not change.
PTS: 1 REF: p. 16 - Roles of the Pediatric Nurse

27. Atraumatic care refers to:

a. care of children without wounds or assaults
b. care that avoids any harm to the child or the family
c. a philosophy of providing health care that minimizes or eliminates physical or
psychological distress for children and their families
d. any care by the nurse, or other members of the health care team, that does not involve an
invasive procedure to the child
ANS: C
Feedback
A Incorrect. Atraumatic care does not refer to caring for children without wounds or
assaults.
B Incorrect. Atraumatic care does intend to minimize or eliminate physical and
psychological distress for children and their families, especially the avoidance of any
harm to the child or family.
C Correct. Three principles provide the basis for atraumatic are: 1) identification of
stressors for the child and family; 2) minimizing separation; and, 3) minimizing or
preventing pain. The minimization or elimination of physical and psychological distress
has been proven to assist the caregiver and the health care professional, and improve the
entire experience for all involved.
D Incorrect. Atraumatic care involves all medical procedures, invasive or noninvasive.
PTS: 1 REF: p. 16 - A traumatic Care

9
28. Which of the following actions by the nurse best exemplifies atraumatic care?
a. using a eutectic mixture of local anesthetics (EMLA) cream 1 hour before blood draws o
the use of any needle
b. requesting assignment to a general medical unit rather than the intensive care unit
c. handwashing when entering the room and before leaving the room
d. reverse isolation for the child who is immunologically compromised
ANS: A
Feedback
A Correct. Examples of atraumatic care include: 1) age-appropriate explanations before
any and every procedure; 2) prior to surgery, helping the child to become familiar with
the hospital, equipment, dress, etc.; 3) pain control; and, 4) local anesthetics prior to
blood samples, IVs, and injections.
B Incorrect. Atraumatic is the avoidance of physical or psychological distress, and has
nothing to do with the trauma unit, the ER, the ICU, etc.
C Incorrect. Handwashing is general hygeine, and has no impact upon lowering or
eliminating the physical or psychological distress of the child patient.
D Incorrect. Reverse isolation violates the philosophy of atraumatic care.
PTS: 1 REF: p. 16 - A traumatic Care

29. Which of the following best describes differentiated practice?

a. having a practice that is different from the usual practices of nurses
b. an area of nursing that is highly specialized
c. delineating a nurse's role and functions according to experience, competence, and
education
d. separating different nursing roles in a hospital and using competency testing to determine
who can fill these roles
ANS: C
a.
Feedback
A Incorrect. Although the word different distinguishes between “a practice” and “usual
practices” of nurses, the primary roles and even the secondary roles of a nurse are
universal and the same.
B Incorrect. Specialization is described by expanded roles, such as pediatric nurse
practitioners, clinical nurse specialists and case managers.
C Correct. Other roles seen in the acute care setting involve differentiated practice (a
philosophy that delineates a nurse’s role and functions according to experience,
competence, and education) and include the clinical care coordinator, care manager, and
clinical nurse.
D Incorrect. Differentiated practice involves experience and education in addition to
competencies.
PTS: 1 REF: p. 20 - Differentiated Practice Roles

OBJ: Cognitive Level: Knowledge
30. Which of the following roles best exemplifies the expanded role of the nurse?
a. medication nurse c. obstetrical nurse
b. pediatric nurse practitioner d. circulating nurse in surgery
ANS: B
Feedback
A Incorrect. All nurses are trained in giving medications, hence, this is not an expanded
role.
B Correct. The pediatric nurse practitioner provides routine health maintenance and
preventive services in ambulatory settings, clinics, or acute care settings. The PNP role is
expanded to include performing assessments and physical exams, counseling, ordering
lab studies, and in many states, prescriptive authority.
C Incorrect. The obstetrical nurse does not have an expanded role.
D Incorrect. The circulating nurse in surgery does not have an expanded role.
PTS: 1 REF: p. 21 - Advanced Practice Roles OBJ: Cognitive Level: Knowledge
10
31. When the pediatric nurse informs children and families of their rights and options, as well as the consequences of opntiso, and facilitates decision
making, the nurse is acting mainly in which of the following roles?
a. leader c. advocate
b. researcher d. educator
ANS: C
Feedback
A Incorrect. The nurse as leader or manager includes the role of caring for one or more
patients as well as managing staff members.
B Incorrect. The nurse as researcher involves the identification of questions needing
answers, pointing the way to areas requiring research and further investigation, and
providing evidence-based practice.
C Correct. The second primary role of the nurse after caregiver is the role of advocate,
from the Latin root for lawyer. When the nurse informs a family of their rights and
options as well as consequences, she is fulfilling the role of advocate.
D Incorrect. The nurse as educator enables the child and family to make informed decisions
about options and outcomes.
PTS: 1 REF: p. 17 - Advocate

32. To be an effective educator, the nurse must initially have a knowledge of:
a. cognitive development
b. the reading level of the recipient
c. what grade level the recipient has attained
d. IQ levels
ANS: A
Feedback
A Correct. Education cannot be effective unless the nurse understands the level of cognitiv e
development of the student, child, or caregiver.
B Incorrect. Reading level does not generally affect the ability to verbally educate, and is
not as critical in the process of learning.
C Incorrect. Grade level for the child will have a link to cognitive development, but
cognitive development is more basic.
D Incorrect. IQ level must be taken into account, but the cognitive level of the child is more
important.
PTS: 1 REF: p. 18 - Educator OBJ: Cognitive Level: Knowledge
33. An appropriate method for teaching preschool children would be:

a. a lecture c. a pretest and posttest
b. a slide show d. imitation
ANS: D
Feedback
A Incorrect. Preschool children cannot benefit from a lecture.
B Incorrect. Preschool children may be entertained by a slide show, but not for very long.
C Incorrect. Preschool children will not learn well through testing.
D Correct. Preschool children are natural imitators, and imitation is an age appropriate
method for teaching.
PTS: 1 REF: p. 18 - Educator

34. Adolescents learn best when they:

a. see an immediate personal benefit c. attend a lecture session
b. need to follow directions d. have a long-term, challenging project
ANS: A
Feedback
A Correct. Adolescents often learn by associating new information with what they already
have learned, but learn best when they see an immediate personal benefit.
B Incorrect. Adolescents do not do the best learning when there is a need to follow
directions.
C Incorrect. Adolescents, like preschoolers, do not learn best attending a lecture session.
D Incorrect. Adolescents, like preschoolers, are very interested in the immediate present.
PTS: 1 REF: p. 19 - Educator

11
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35. Which of the following activities best exemplifies cognitive learning?
a. sharing feelings and ideas in a group of peer
b. working with clay or sand and water
c. drawing, finger painting, or painting with watercolors
d. describing or explaining something, or answering questions
ANS: D
Feedback
A Incorrect. Affective learning involves sharing feelings, emotions, and ideas in a group of
peers. These activities do not exemplify cognitive learning.
B Incorrect. Psychomotor learning is concerned with physical skills such as working with
clay or sand and water.These activities do not exemplify cognitive learning.
C Incorrect. Psychomotor learning involves drawing, finger painting, or painting with
watercolors. This is not an example of cognitive learning.
D Correct. Cognitive learning is concerned with intellectual activities, can be compared to
thinking, and involves describing or explaining something or answering questions.
36. Affective learning activities would include:

a. taking a pretest before a lecture c. one-to-one sharing of feelings and ideas
b. making a stage set for a school play d. trying out for the basketball team
ANS: C
Feedback
A Incorrect. Taking a pretest before a lecture would involve cognitive learning, intellectual
activities, thinking, and answering questions.
B Incorrect. Making a stage set for a school play would involve mind and body, which is
psychomotor learning.
C Correct. Affective learning is learning that takes place in relation to feelings and
emotions, for example, role-playing, modeling, or one-to-one discussion about feelings
and ideas.
D Incorrect. Trying out for the basketball team involves psychomotor learning.
37. Psychomotor learning activities include:

a. hands-on experiences, repetition, and immediate feedback
b. role-playing or modeling
c. sharing feelings or ideas with a peer and getting feedback
d. processing what happened in a group activity
ANS: A
Feedback
A Correct. Psychomotor learning activities involve the mind and the body, such as
demonstration and then practice with hands-on experiences, repetition, and immediate
feedback.
B Incorrect. Role-playing and modeling are examles of affective learning.
C Incorrect. Sharing feelings or ideas with a peer and getting feedback is an example of
affective learning.
D Incorrect. Processing what happened in a group activity will more likely be engaged with
cognitive learning.
38. When the nurse is in the nurse manager role and delegates a task to someone else, the nurse manager is:
a. free of any responsibility for the task
b. held accountable for the task only if the delegate is not able to complete it
c. supposed to check on the work
d. still held accountable for the task
ANS: D
Feedback
A Incorrect. The manager does not abandon responsibility with delegation.
B Incorrect. Accountability is retained by the manager regardless of the cause for the
failure to complete the task.
C Incorrect. A delegated task accepted by someone else does not require the manager to
check on the status.
D Correct. The nurse manager retains accountability for the outcome of all delegated tasks.
PTS: 1 REF: p. 20 - Manager/Leader OBJ: Cognitive Level: Knowledge
12
39. The character of a nursing unit is determined mainly by the:
a. nurse manager c. physicians
b. nursing staff d. administration
ANS: A
Feedback
A Correct. Nurse managers determine the character of the unit, attitudes and behavior of
the staff, and relationships with other professionals at the agency.
B Incorrect. The nursing staff influence the character of the unit, but do not determine it.
C Incorrect. The physicians do not spend as much time at the nursing unit, and do not
determine the character of the unit.
D Incorrect. The administration is responsible for the facility, but do not determine the
character of the unit.
PTS: 1 REF: p. 20 - Manager/Leader OBJ: Cognitive Level: Knowledge
40. Which of the following nursing practice groups is able to order, carry out, and evaluate laboratory studies?
a. nurses with associate degrees c. pediatric nurse practitioners
b. baccalaureate-prepared nurses d. case managers
ANS: C
Feedback
A Incorrect. Nurses with associate degrees do not have authority nor training to order, carry
out, and evaluate lab studies.
B Incorrect. Baccalaureate-prepared nurses do not have authority nor training to order,
carry out, and evaluate lab studies.
C Correct. The Pediatric Nurse Practitioner is able to order, carry out, and evaluate
laboratory studies; discriminate between normal and abnormal findings that require
treatment, referral, or collaboration with other health care professionals; and identify
topics, interpret results, and implement evidence-based findings into practice.
D Incorrect. Case managers are responsible to minimize fragmentation of services and
maximize individualization of care.
PTS: 1 REF: p. 21 - Pediatric Nurse Practitioner OBJ: Cognitive Level: Knowledge
41. Clinical pathways are developed to guide a health care team through a client's course of therapy. Their major purpose itso:
a. provide early warnings about the approaching need for higher level care
b. achieve specific client outcomes in a defined time frame
c. satisfy standards of accrediting organizations
d. simplify the work of the nursing staff and the health care team
ANS: B
Feedback
A Incorrect. The development of clinical or critical pathways as a function of case
management is not involved in predicting an approaching need for higher level care, but
is aimed at achieving the best possible outcome in the shortest time.
B Correct. Clinical pathways were developed and designed to achieve specific client
outcomes in a defined time frame.
C Incorrect. Clinical or critical pathways are not designed to satisfy accreditations.
D Incorrect. Although clinical or critical pathways may simplify the work of the nursing
staff and the health care team, they are not designed for this purpose.
PTS: 1 REF: p. 22 - Case Manager OBJ: Cognitive Level: Knowledge
42. Critical pathways are designed to indicate:

a. key events that must happen each day in order to achieve an acceptable length of stay
b. actions that are acceptable by the health care team and actions that are not acceptable
c. the client's responsibilities in working with the health care team
d. turning points in which the client is not progressing normally and requires more critical
care
ANS: A
Feedback
A Correct. Critical pathways provide a detailed plan which guide the team through the
client’s course of therapy, indicating key events which must occur each day in order to
achieve an appropriate length of stay.
B Incorrect. Critical pathways are focused upon the patient, and not the health care team.
C Incorrect. Although the client is involved, critical pathways are focused upon the key
therapeutic events necessary to complete the desired outcome by a stated time.
D Incorrect. Critical pathways do not contemplate abnormal progress.
13
43. Case management is a practice model that was developed to:
a. provide supervision for a team of nurses who are working independent
b. minimize fragmentation of services and maximize individualization of care
c. reduce costs of health care through better organization of care
d. track large numbers of cases supervised or served by a health care organization
ANS: B
Feedback
A Incorrect. The nurse manager provides supervision for the nursing team.
B Correct. The case management practice model was initially developed to minimize
fragmentation and maximize individualization of care. Quality and cost outcomes are
important to case management.
C Incorrect. Case management involves cost reduction but also focuses upon quality
outcomes.
D Incorrect. Case management is a practice model assuring maximized individual outcome
success, and does not get involved in tracking large numbers of cases.
MULTIPLE RESPONSE
1. A nurse is providing an educational series on the prevention of injuries. Which of the following interventions identidfibey the nurse are examples
of key approaches in the prevention of injury? Select all that apply.
a. helmet safety programs
b. covering electrical outlets with safety covers
c. legislation
d. regulation
ANS: A, B, C, D
Feedback
Correct All are correct. The key approaches to injury prevention include education,
changes in the environment and in products, and legislation or regulation. A helm et
safety program would be a form of injury prevention education. Covering
electrical outlets with safety covers is one example of changing the environment t o
promote safety.
Incorrect All answers are correct.
PTS: 1 REF: p. 14 - Child Mortality OBJ: Cognitive Level: Application
2. Which of the following roles for the pediatric nurse are considered advanced practice? Select all that apply.
a. pediatric nurse practitioner c. clinical care coordinator
b. clinical nurse specialist d. case manager
ANS: A, B, D
Feedback
Correct Pediatric advanced practice roles include pediatric nurse practitioner, clinical
nurse specialist, and case manager.
Incorrect The clinical care coordinator role is a differentiated practice role.
PTS: 1 REF: p. 97 - Table 4-1

14
Exploring the Variety of Random
Documents with Different Content
also, must be added the fact that, for the first two
years, the new schools were carried on by means of
her own liberal donations and those of her personal
friends. It was not to be expected that she could
hold the same relation to her governing body as the
ordinary head-mistress, who is appointed by them,
and over whom they have the right of dismissal.
It was perhaps a little unfortunate that at the time
of special difficulty, the chairmanship seemed to have
become permanent in the appointment of a
chairman, who, however fitted for the post, was yet
only imperfectly acquainted with the early history of
the school, and, therefore, not unnaturally gave
undue weight to the help given by the Board,
regarding the new scheme rather as an entirely fresh
departure, than as what it actually was, merely the
expansion of an existing organization, and still
dependent on the skill to which it owed its rise. He
had been accustomed to long-established
foundations, where everything went by rule, and to
committees where the word of the chairman was
law. Miss Buss was used to supreme power over her
own school, and she was, like most women of that
day, unused to business routine. This was, moreover,
one of the very first governing bodies on which
women were elected on equal terms with men. Such
an arrangement was too new as yet to go without
hitch. It would follow, quite naturally, that men, out
of mere force of habit, as well as in real kindness of
heart, should adopt a paternal and authoritative
attitude towards all women, even to those most
competent to stand alone.
Miss Buss was by nature one of the least self-
assertive of women. She had always been helped by
some strong man, and had accepted all help with
gratitude. First Mr. Laing, and then Dr. Hodgson (with
her father and brothers, as a matter of course), had
been recognized as friends and helpers.
But, at the same time, one of the most definite
aims of her life had been to raise the status of the
head-mistress to the same level as that of the head-
master. For the sake of all teachers—not for her own
sake—she deprecated the secondary place given to
women who were doing the same work as men. She
also thought the internal management of her school
should be left to her, as it would have been to a
head-master in her place, and for this she stood firm,
even when, as a matter of mere feeling, she might
have given way, for she was really one of the old-
fashioned women who would personally endure
anything for the sake of peace.
It is more than probable that she felt some things
too strongly, and that she misunderstood others. In
those days, most women suffered quite needlessly
from sheer ignorance of business routine. They
lacked the training and discipline which carry men
unscathed through the roughness of public life. Two
men meeting on a committee may oppose each
other tooth and nail, but these men may afterwards
go home and dine comfortably together, bearing no
traces of the fray. At that date, two women, after a
similar encounter, would have gone their separate
ways, to weep over a solitary cup of tea, and when
next they met would pass each other with the cut
direct.
To a woman like Miss Buss, nothing of this sort
would have been possible, for even if she had not
had too much common sense, she had that most
uncommon power of forgiveness which led to the
saying, “If you really want to know how kind Miss
Buss is you must do her some injury!”
Nevertheless, however evanescent her feeling
might be, she did for the time feel her worries very
intensely. It chanced that, as my way lay beyond
Myra Lodge, I usually drove her home from the
meetings, and she then relieved her pent-up feelings
by rapid discussion of any vexed question from her
own point of view. By the time our drive ended, she
was, as a rule, quite ready for her ordinary meal, and
we parted more often than not with a jest, for this
process was merely a question of “blowing off the
steam,” and I served as safety-valve. It was entirely
a matter of temperament. Whilst some
temperaments fail to perceive the existence of a
grievance until it is formulated in words, others can
throw off in words all the bitterness of even the
worst grievances. Miss Buss belonged to the latter
class, and, as I understood this thoroughly, I could
forget her words as soon as spoken. Where such
hasty utterances were taken seriously by persons of
the opposite temperament, she was at times
seriously misunderstood.
During the nine years of suspense between the
changes of 1870 and the opening of the new
buildings in 1879 there was much to try the most
perfect patience. Here is a little note showing the
kind of thing that used at first to cause a protest—
“My very dear little Annie,

“I feel a little ashamed of my impatience to-day, but am
happy to find that Miss Elford was in the same frame of
mind. Lady X. talked quite wildly about this and that, and
what ought or ought not to be. These ladies have not an
idea beyond the parish school, where the lady of the manor
is supreme, and dictates to the children what they shall wear,
and what they shall not, how to do their hair, etc., etc. If it
were not so pitiable in its ignorance I could find it in my
heart to cry, or to run away and leave the board to manage
its schools.
“How very thankful I am that you have always a soothing
effect on me. My dear love to you,
“Arnie.”
This was probably one of many instances in which

Miss Buss suffered from an imperfect knowledge on
the part of the public. Endowments for girls’ schools
were still so novel that the demand for money for the
Camden School was, in some absurd way, associated
with the Founder, as if she were herself a recipient,
instead of being, as she was, one of the most
generous of donors, giving herself and her means for
the public good.
For example of the sort of trial involved in working
with a committee to one so used as Miss Buss had
been to direct, rapid and free action, we may take an
experience in 1872, when the governing body, intent
only on saving her trouble in the temporary absence
of the Rev. A. J. Buss (Clerk to the Board), appointed
a special Prize Day Committee. It had been decided
that, to bring the work more clearly before the
public, the Princess Louise should be asked to give
the prizes in the Albert Hall. We give Miss Buss’
report from her Journal-letters—
“June 22.
“I went yesterday to the Albert Hall and heard that it was
let for the 19th.
“The secretary was very polite, however, and, finding he
had to do with a princess, got the date altered to suit us.
The fees will cost £30. The secretary says we ought to
distribute bills through the exhibition, besides advertising,
and let people in who choose to pay for entrance. This will
require consideration on Monday.
“Mr. Roby will speak, and I mean to ask him to say what
Miss Davies has done for education. On Saturday there is a
conference of teachers in the rooms of the Society of Arts.
We shall see plenty of people there, and can ask some one
to speak. Dr. Lyon Playfair is to take the chair.
“For the day itself we must invite thousands. Every
member of Parliament, every member of a city company,
every clergyman and Nonconformist of note. Invite all the
press, all known educationalists, etc., etc.
“Let us hope we shall have our own hall by next year, and
then we shall not need to go away from home.”
“July 2.
“Mr. Forster can’t take the chair. Lord Derby declines, and
now, at 2 p.m., comes a note to say the Princess Louise will
not be able to attend!
“Dr. Storrar goes to-morrow morning to see Mr. Holzmann,
and consult with him. We hope to get access to Princess
Mary.
“If not where are we? Curiously enough, this sort of thing
does not worry me—at least, not much.... Nothing but the
necessity of working with other people would have made me
allow the matter to be so delayed. June is our month, and
always has been. However, I am quite cool about matters.
The inevitable must be endured.”
“Myra Lodge, July 11, 8 a.m.

“The chairman sends Col. Airey’s note to say Princess Mary
declines. I shall go at once to consult Mr. Elliott.”
“202, Camden Road, July 11, 11 a.m.

“Mr. Elliott is going to try the Duke of Edinburgh. I am to
get rid of the Albert Hall, however, coûte que coûte.
“Everything is at a standstill. Never in my working life has
there been such a complete fiasco.”
“July 13.
“I must write later to answer your notes fully, but, at 8
o’clock this morning, I went to our vicar, Mr. Cutts, for a note
to the bishop’s chaplain, whom I do not know. I then went to
Mr. Elliott; returned to breakfast, and then dashed out with
the fixed determination not to return until the Prize Day
arrangements had been made.
“I drove in the storm to St. James’ Square (London
House), Bishop not there, but at Fulham; drove to Fulham,
sent in my note to the chaplain, who saw me at once, and
asked me to go to the bishop. I said I wanted to ask a
question, and would not disturb him if possible. So Mr.
Gamier took in my message, ‘Would the bishop preside for
even half an hour at our meeting—on any hour and any day
in the next fortnight.’
“The bishop positively had not one hour available. He went
through his list, but he would give me Monday, the 29th, at
3 o’clock. Of course I accepted, rushed away to St. James’
Hall—not to be had anyhow for two months—thence to
Willis’ Rooms, which we can have.
“How much I regret allowing a committee to be formed! If
Mr. Elliott, Mr. Danson, and I had been empowered to act, we
should have had one of the Princesses. There would have
been no delay by notes going first to the chairman and then
having to be sent to me. If I had had the note of Princess
Louise’s secretary at 8 a.m., by 10 I should have been at her
house, and should certainly have got an introduction to
Princess Mary. In this case, the memorial to the latter would
have been in her hands by Saturday morning, instead of
Tuesday! and would have been accompanied by a note from
either Princess Louise or Lord Lorne.
“Don’t think me very egotistical, but don’t expect me to
summon a committee for the Prize Day again.
“I shall quietly go my own way now, and do the things.
That last committee took up two hours and twenty-five
minutes of my time in the middle of the day, and for what? (I
told you two hours, but made a mistake.)
“I forgot to say I went to the printer, ordered all the
invitations, and expect them on Monday. But Willis’ Rooms,
though handsome, are not large. With every card we will
send out the slip about Princess Louise’s failure in her
engagement.”
The meeting went off as well as these meetings

always did. But next year the Princess Mary of Teck
was secured without difficulty; as well as afterwards
several other members of the Royal Family, including
even the Prince and Princess of Wales.
It must have been at this period that an equally
characteristic little story is told. Miss Buss, in the
height of her vexation, sought comfort beside her
sister and her boy. As she entered the room, she
exclaimed, “This is what I have brought on myself,
and for what?” with an impatient stamp of her foot.
Baby Frank lifted his great eyes solemnly to his aunt,
and, with a deliberate stamp of his baby foot,
echoed, “And for vot?” on which, as she clasped him
in her arms, all her indignation vanished in a shower
of kisses.
But that she did not demand mere acquiescence
from her friends is proved by many of her letters,
one of which may be given, not only as showing her
many-sidedness, but also as revealing the true
humility which was the secret of her strength.
She had been long overstrained by anxiety and
suspense, and had to some extent lost patience
under the many demands on her. At one time,
indeed, she even entertained serious thoughts of
resigning her post unless things could be made
easier for her by the assurance of greater freedom of
action. On the occasion of this particular letter, the
usual talk had failed, and I must have written that
same evening still more strongly, urging either a
more complete submission to the inevitable, or else
some bold stroke for liberty. She thus responds—
“Late as it is, and in spite of a distressing headache, I
must just write a few words to say how much I love and
thank you for your note. The advice in it I will try to follow.
“Yet, dearest Annie, it tears me in pieces to have to be
always asserting myself. But it seems to me to be impossible
to go on without a certain amount of freedom of action.
“Dearest Annie, I sobbed myself to sleep like a child, such
a thing not having occurred for years. The Mystery of Pain!—
if it were a clear duly to bear it, I would go through
anything, but I cannot see the duty, and can feel the pain....
“You must take me as I am, dear Annie, with all my
failings. If I am too impetuous, too energetic, too rash, these
are all part of such virtues as I may possess, and, without
the two first, the work that I have done would never have
been done; and the last I do not think I am. Other feelings,
of course, I have, unconscious and unknown to me. But take
me as I am.
“I had a long and grave talk to Miss ——, who counsels
fight, but not on any personal ground. She says, ‘Resign, if
there is interference with the mistress’ liberty of action. That
is a public question, and one of public interest.’
“She was so good and loving; she was so tender; and she
is so wise and calm.
“She told me some of her own worries, and said that
sometimes she quivered in every nerve at her own council
meetings. People came in and asked for information,
involving hours of work for no result; ignored all that had
been done, and talked as if they alone had done everything
and knew everything. She urged me to try and be
impersonal, so to speak; to remember that these and similar
difficulties would always occur where there are several
people. She said that women were always accused of being
too personal, and harm was done by giving a handle to such
an assertion.
“Dearest Annie! I must try to follow your advice, and think
of the work and not of myself. Please help me! Be a true
friend, and don’t fear saying even unpleasant things to me if
you think them deserved. I shall not quarrel.
“Worried and annoyed as I have been, I have never in my
whole life been cut by, or had a quarrel with, even the most
absurd parent! But you know I am to give in my resignation,
if a public question, such as payment of teachers, hours of
work etc., is raised.”
There were few head-mistresses who in those

early days escaped some such trouble. Referring to
one very well-known instance, in 1874, Miss Buss
remarks—
“I see they are still in a state of fight at Milton Mount;

there seems to have been a great storm at the annual
meeting. I am so sorry for Miss Hadland, who is one of the
best and bravest women I know. I feel that she has fought
for a principle, and not in mere self-assertion. It is hard
discipline to be thwarted at every turn when she has only a
single eye for the children’s best education for this life and
the next. Any worries that I have had in the past sink into
insignificance compared with Miss Hadland’s.”
The recurrence of such difficulties rendered it

desirable that the head-mistresses should take
counsel together, and try to secure some firm and
settled line of action which might lead to the
avoidance of misunderstandings between themselves
and their governing bodies.
There was already in existence a very useful
“School-Mistresses’ Association,” of which the head-
mistresses were all members. But, as including
assistant-mistresses, private governesses, and even
the “mere amateur,” these meetings were better
adapted for the discussion of general educational
questions than for the special difficulties of one
branch of the profession.
Miss Buss had been one of the most active
members of the School-Mistresses’ Association,
which had its origin in a suggestion made by Miss
Davies, to which reference is made in a letter, dated
December, 1865, from Miss Buss to Miss Davies—
“I think your proposal about the meetings admirable. The

first meeting with men, Mr. Fitch, or some one, in the chair;
the rest modelled on the Kensington Society.[12] But where
you will get your papers from, is the question! There is so
little leisure in a teacher’s life.
“I think it would be useful and pleasant to meet the
Assistant-Commissioners, and hear some of their experience.
Such a meeting might be annual, and the others quarterly. I
mean a mixed meeting of men and women for the annual,
because, after the Commission ceases to sit, I suppose the
Assistant-Commissioners will disappear.”
12. The “Kensington Society,” to which reference is here made, is
thus described by Miss Davies—
“The Kensington Society was not exactly an educational union,
though it arose out of the agitation for the local examinations.
I had, in working for that, made acquaintance, partly by
correspondence, with a good many people of kindred interests.
It seemed a pity that we should lose sight of each other when
that particular bit of work was accomplished; so a little society
was formed to meet and read papers from time to time. Mrs.
Manning, the step-mother of Miss Adelaide Manning, was
president, and as the meetings were often held at her house in
Kensington, we took that name. Miss Buss was a member, but
did not take an active part. This society lived, I think, for about
three years.”
The School-Mistresses’ Association was finally

started in April, 1867, with Miss Davies as honorary
secretary. Miss Buss became president in the second
year.
In an early report, reference is made to a
suggestion from Miss Clough, which led to the first
action having for its object co-operation among
teachers. It was ascertained that—
“While practically school-mistresses were singularly

isolated, some teachers having scarcely so much as a
speaking acquaintance with any professional associate, such
isolation was involuntary, and felt to be a great drawback to
usefulness. It was agreed to meet together, at stated times,
for the discussion of subjects specially interesting to
teachers.”
A Library Committee, with Miss Gertrude King as
secretary, undertook the formation of a Teachers’
Library, and of a Registry for Professors. With the
exception of the attempt of the Governesses’
Benevolent Institution, this seems to have been the
first effort made by any educational body towards
duly qualified and certified teaching.
The meeting mentioned in Miss Buss’ letter was
held, early in 1866, at the house of Miss Garrett
(Mrs. Garrett-Anderson), and was attended by
several of the Assistant-Commissioners, and by other
persons interested in the new movements. Matters
relating to the Schools Inquiry—still in progress—
were discussed, as well as the question of education
in general.
A valuable series of papers on general educational
points, by able writers, was issued by the
association, and various technical questions were
fully discussed; but the larger movements, such as
the Local Examinations, and the proposed Woman’s
College at Hitchin, occupy a very prominent place in
the report which dwells on what is the true basis of
any useful association—
“Apart from any tangible results, it has been felt that the
recognition of a common bond—the kindling of zeal and
courage, by the contact of congenial minds—the cheering
consciousness of sympathy in working together for a great
end, amply justify the existence of such an association.”
The School-Mistresses’ Association continued its

work until the increase of the new Endowed Schools
made a division of its members into three distinct
classes, head-mistresses, assistant-mistresses, and
private governesses. The two first formed themselves
into distinct associations, while the third was
absorbed by the Teachers’ Guild, which also drew in
the amateurs.
Having fostered and protected this threefold
fruitage up to the period of ripening, the parent
association then fell apart, its work being done.
The Teachers’ Guild was originated by Miss Buss,
at a meeting held on February 7, 1883, at the North
London Collegiate School for Girls. On May 16 it was
formally inaugurated at a meeting of the School-
Mistresses’ Association, and it was then taken up
warmly by the Head-mistresses’ Association.
Of the rise of the Assistant-mistresses’ Association,
Miss E. P. Hughes writes, referring to the help given
by Miss Buss—
“In 1884, at a little meeting in my room at Newnham, it

was decided to start the Assistant-mistresses’ Association,
the initiative being left to Mrs. Corrie Grant, Miss Eves, and
myself. I wrote to Miss Buss and to several other leaders in
education. Miss Buss’ answer was the first we received, and I
distinctly remember the impression it produced. She
sympathized keenly with the desire for union, seeing at once
the possible danger of antagonism to other associations, but
also seeing the way to avoid this danger. Without her
sympathy and advice I do not think the association would
have been started just then.”[13]
13. That Miss Buss’ interest did not relax is shown by the
resolution passed by the Assistant-mistresses’ Association after
the news of her death: “A great loss has fallen on the
profession, a loss we should call irreparable did we not know
that no devoted service dies, but lives and bears fruit in many
wonderful and unexpected ways. A great worker has been
called to her rest, and we who remain seem little as compared
with her who is gone. As teachers we must all feel how much
we have lost, while to some the loss is dearer and more
personal.”
Miss Buss and Miss Beale may claim to have

started the Head-mistresses’ Association, with the
help of Miss H. M. Jones and a few others, who met
at Myra Lodge in the Christmas vacation of 1873, to
formulate its constitution.
In her memorial notice,[14] Miss Toplis tells us that
the name of this new association was due to Miss
Buss, as she says—
14. Educational Review, January, 1895.
“How many of those who now hold the honourable
position and title of head-mistress know that they owe this
title to her? She had succeeded in convincing the authorities
that in the new schools which were to come into existence a
woman could be the actual head, and that there was no
need to put her and her school under a man as director
(which was the only idea that occurred to them); and then
arose this question, what should the lady be called?—
superintendent, lady-principal, director? ‘A thought flashed
into my mind,’ she used to say, ‘if head-master, why not
head-mistress, as the exact equivalent?’ And, much to my
surprise, the suggestion was immediately accepted.”
Miss Buss became president of the association,

retaining the office till the end, when her place was
taken by Miss Beale; the duties during the long
illness being undertaken by Miss H. M. Jones, as
deputy-president.
Miss H. M. Jones, in a letter on Christmas Day,
1894, speaks for the whole body in her expression of
sorrow—
“How many will feel to-day that they have lost a friend on
whose judgment and advice they could always rely! Few
women have exercised so great an influence on the
educational movements of the present day, and still fewer
have worked so hard as she has done to secure the greatest
possible advantages to the girls of this and future
generations. She will be greatly missed and greatly mourned.
“It is just twenty-one years ago that a few of us head-
mistresses met during the Christmas holidays to establish the
Association, of which she has since then been the honoured
president, and in which she always took so great an interest.
In fact, as you know, Miss Buss has been foremost as a
leader in all our deliberations and in all our efforts.”
Miss Elsie Day, of the Grey Coat Hospital,

Westminster, adds a very interesting fact in the
history of the Association; as, after the expression of
personal grief, she says—
“She was emphatically the mother of the head-mistresses.

We looked to no one, as we did to her, for wise and loving
help. For myself, I can only say I have loved her for twenty
years.
“What I am anxious for is, that in any notice of her, when
it would be suitable, it should be mentioned that it was at
her request that, when the Head-mistresses’ Association met
here, in 1885, there was a special celebration for the
Association. She wrote in the sweetest and most modest
way, asking me if I saw my way to it, and Canon Furse
celebrated at my request. Such an early celebration has been
held and much appreciated almost every year since.
“It is because I believe that I have had the credit of
initiating this that I am desirous that it should be known
that, although I made the arrangements, the thought was
hers. We want to help the younger heads to realize her
beautiful unwitting saintliness.”
Another friend among the head-mistresses, whom
she often visited, tells how at night Miss Buss liked
that they should kneel down, and together say the
Veni Creator.[15]
15. This simplicity and devoutness are well shown in a letter to my
father, in reply to a poem which he had sent her. He was for
many years an invalid, and Miss Buss kept him in constant
remembrance in sending flowers or books. She knew that she
was never forgotten in his prayers—
“Myra Lodge, December 4, 1883.
“Dear Mr. Ridley,
“It is very good of you to write to me, and I shall take
great care of your letter. Miss Hickey’s poem is very beautiful
and suggestive. In my intensely active life I do feel, at times
especially, the need of spiritual uplifting. Early last week,
before your letter came, I had felt this from joining a
communion service in the house of a dear friend, whose only
child, a grown-up son, was dangerously ill.
“I know very little of thought-transference, but I wonder
whether in some wonderful and mysterious way this craving
was made known to you.
“With my love and earnest thanks,
“Believe me, dear Mr. Ridley,
“Yours most truly,
“Frances M. Buss.”
Those who knew her best know best the force of

the description given of her by her friend Miss Beale
in her deeply appreciative sketch[16]—
16. Guardian, January 9, 1895.
“How full of prayer was her life only a few intimate friends
know; one felt that for her the words were true, ‘They that
wait on the Lord shall renew their strength;’ and one is glad
to think that these words are in a higher sense true for her
now—
‘I count that heaven itself is only work

To a surer issue,’
and that those who have entered into rest, yet

rest not, but in their glorified life give utterance
to that fuller vision of holiness which was once
hidden by the clouds of earth.”
The prayerful attitude of spirit characteristic of all

who live “as seeing things invisible” must tend to the
graces of simplicity and humility. Nothing was more
touching than to note these special graces in one so
strong and so capable, so eager and impetuous, and
dowered with a will that swept everything before it.
Her own personal wants were of the simplest, and no
one ever gave less trouble to those around her. From
Mr. Latham, who, as secretary to the Endowed
Schools’ Commission, saw most of her in her public
life, comes a very striking testimony to this point in
her character when, after acknowledging with full
appreciation how she “has done the state good
service,” he adds—
“The simplicity of her life and the tranquillity of her

demeanour always seemed to me to mark her out in rather a
special way among her comrades in the cause of the
education of women and girls, of which she was a most
distinguished pioneer.”
Amid the apparently endless multiplicity of her

objects in life ran the one simple purpose of faithful
service, and thus in all complexity there was still a
complete order. Confusion is the result only of the
clash of selfish aims with social duties. To the “heart
at leisure from itself” life must always remain simple
and harmonious.
To this humility Miss Beale also bears witness,
touching first on a point of special interest in
connection with their professional work—
“The next thing that struck us was her generosity, not only
in money—though that was very great—but in personal
service, in thoughtfulness of others. If there was any
improvement she could suggest in organization, in methods
of teaching, she made it her business, at no little expense of
money and time, to distribute the information to others;
never considering them as rivals, but as fellow-workers, in a
common cause.
“Next to her charity, one was impressed by her humility.
‘Let each esteem other better than themselves,’ was the rule
of her own life, while she always seemed to look for
excellences, rather than failings, and to seek to develop, in
all, the right emulation, ‘If there be any virtue, any praise,
think of these things.’”
One of our greatest teachers tells us that “the test

of a truly great man is his humility,” and certainly to
the small, self-centred soul no grace is more difficult
of attainment.
This humility was very striking in its contrast with
the strength and power of this strong woman. In
things large or small it was the same; she was the
first to admit, either to teachers or pupils, any error
of judgment, or any small seeming
inconsiderateness, so easy in her terribly
overcrowded life. Of this, one of the staff says aptly
—
“She had also the power, so often wanting in a strong

leader, of acknowledging a mistake. I shall never forget the
impression made on me on receiving a note from her,
apologizing for what I might perhaps characterize as a failure
in courtesy. That was several years ago, but even then she
was able to plead the pressure on her nerves of the work
whose magnitude none of us can ever know.”
And one of the party of a Roman holiday relates,
with moist eyes, how, one day when she had retired
to her room, up a long flight of stairs, she heard a
knock at the door, and there found Miss Buss, who
had followed her all the way up just to say, “I am
afraid, my dear, that I passed you without saying
good morning; but I was thinking of something else
at the moment, and only remembered it afterwards!”
In speaking of “our dear friend and helper, Miss

Buss,” Miss Cooper, of Edgbaston, takes up the
lesson of the life just closed, as she says—
“The whole of the educational world will grieve, and will

feel the void caused by her death. But the full realization of
the loss can only be felt by those who were drawn into the
more intimate personal and professional relations in which
Miss Buss showed her great and generous spirit in the best
aspect.
“It is of the greatest help to remember the brave and
loving spirit just gone from us, and to recall not only her
words of hope and cheer to us, but also her encouragement
to take up her work when it had perforce to be given up;
and, in our turn, to help the younger members of our
profession both in their own daily needs and difficulties, and
also in their endeavour after a life that should realize the
highest ideals with which such leaders as Miss Buss have
inspired us.
“From such help as she gave us, one learns the gospel of
helpfulness for others, and her life has inspired, and will
continue to inspire, some of the best work that has made
education a real and valuable thing for the women of
England—work which has still to develop into greater
usefulness as greater opportunities are presented to it.”
And, over and over, from the younger members of

the association, come in varying form the same
heartfelt utterances of personal loss, as in this—
“I cannot tell you how much she helped me from the first
time I met her, when I went from the Cambridge Training
College to work under her at her own school, till I left to
become head of the West Ham School. There I rejoiced in
having her as one of my governors, and there she has given
me help and encouragement that I never can repay. But I
know I am only one of many whom she taught and advised
without a thought of the trouble to herself.”
Never, surely, had formal vote of condolence less

of mere form, or more of love and sorrow than that
sent by the Head-mistresses’ Association to the
friends of their “honoured and beloved president,” as
they say—
“As a body, we lament the loss of our head; as individuals,

we mourn a dear and honoured friend, who, whether in the
cause of public progress or of private friendship, was ever
ready to spend herself, her time, and thought for others, and
share with them the fruits of her sound judgment and
experience.
“We appreciate most thoroughly the splendid work that
she accomplished in the sphere of education, and the
important part she played in gaining for women the great
educational advantages which they now enjoy, but for the
moment we are more disposed to dwell upon her personal
influence, her wide sympathies, her never-failing readiness to
give help and counsel, her public spirit, and her loyal,
affectionate disposition.”
CHAPTER XI.
UNIVERSITY EDUCATION FOR WOMEN.
“That human beings, whether male or female, come into

the world not merely to ‘get a living,’ but to live; that the life
they live depends largely on what they know and care about,
upon the breadth of their intellectual sympathy, upon their
love of truth, upon their power of influencing and inspiring
other minds; and that, for these reasons, mental culture
stands in just as close relation to the needs of a woman’s
career in the world as to that of a man—all these are
propositions which, if not self-evident, are at least seen in a
clearer light by the people of our generation than by their
predecessors.”—J. G. Fitch.
“The thing that vexes me is the entirely ignoring Miss Emily

Davies, to whose hard work it may fairly be said the whole
movement is due. She memorialized the Endowed Schools
Commission to include girls in their inquiries; she bore the
brunt of the fight about getting the Cambridge Local
Examinations open, and she called Girton into existence.”
So wrote Miss Buss to Dr. J. G. Fitch, in 1879,

when roused to protest against some statements in a
book entitled, “Girls and Colleges for Women,” which
appeared at that date, and especially to protest
against what invariably roused her deepest ire—the
failure to give honour where honour was due. Of her
it might always be said that she fulfilled the lovely
law of Christian life, “In honour preferring one
another.” As Miss Davies says, in reference to the
passage just quoted, “It was like Miss Buss, so full as
she was of generosity, to be eager in protest against
what she regarded as a slight to another, not
herself.”
Constantly recurrent, in speech and in writing, do
we find testimony of the value attached by Miss Buss
to the University Local Examinations, of which she
was among the first to make use.
It was in consequence of the exertions of Miss
Davies, assisted by Miss Bostock, of Bedford College,
and a small band of steady supporters, that, in 1863,
girls were, for the first time, and in an informal way,
allowed to try the examination papers set for boys.[17]
17. Extract from the first circular—
“A committee of ladies and gentlemen interested in female
education have made arrangements for holding examinations
of girls in connection with the University of Cambridge,
commencing December 14. Prizes and certificates of
proficiency will be awarded by the committee, following the
recommendations of the examiners.
“The examinations will be conducted in accordance with the
Regulations of the Cambridge Local Examination, but in a
private manner and under the superintendence of the ladies of
the committee.
“The committee included the names of Miss Bostock, Miss Isa
Craig, Russell Gurney, Esq., G. W. Hastings, Esq., James
Heywood, Esq., Dr. Hodgson, Mrs. Manning, Mrs. Hensleigh
Wedgwood, Mr. H. R. Tomkinson, Esq., with Lady Goldsmid as
treasurer, and Miss Emily Davies as hon. sec. The same
committee worked for Girton College, with the addition of Lady
Stanley of Alderley, Lady Augusta Stanley, Miss Shirreff, Mrs.
Russell Gurney, Miss Ponsonby, Miss Rich, Miss F. Metcalfe, Mr.
Bryce, Mr. Roby, and Mr. Gorst.”
It was not then known if they were even capable

of the necessary mental effort. The result, however,
proved so satisfactory that the next year saw the
formation of a “London Centre for Girls,” of which
Miss Davies was honorary secretary until Girton took
up her time, when she was succeeded by Mrs. Wm.
Burbury.
To the first irregular examination in 1863 Miss Buss
sent in 25 girls out of the total of 80. Much to her
surprise, ten of her pupils failed in arithmetic, with
the result that she so reorganized her system of
teaching that henceforth few of her girls failed in
that subject.
Between the years 1871 and 1892 no less than
1496 pupils passed in the Cambridge Local
Examinations, of whom 494 took honours.
There is an amusing letter to Miss Davies just
before the examination of 1865, which shows how
these things looked thirty years ago—
“12, Camden Street, Dec. 5, 1865.

“My dear Miss Davies,
“Pray excuse my not answering your note till now. I am
literally ‘over head and ears’ in work. There is so much to
look after just now.
“Those dreadful Cambridge examiners! Their digestion
would certainly be impaired if they only knew how indignant
I am with them. Why, the time hitherto allowed for an
examination is an ‘insult’ to us; but now they have added
‘injury,’ by curtailing the time for English subjects—English,
too! The subject in which a girl might hope to pass with
credit! But we must endure it, as we can’t cure it.
“No doubt you are blissfully ignorant of the change. You
are not an unfortunate school-mistress, with a reputation to
maintain!
“And our girls! We sometimes think they have taken leave
of their senses. Either we have taken up too much, or they
are hopelessly stupid. I almost fear the former.
“Is the Cambridge Exam. to take place at that room in
Conduit Street? And, please let the unhappy victims have
plenty of paper before the bell rings. And I hope Miss Craig
or Miss Bostock, or some one, will be there to help you in
distributing the examination papers, wherever there is any
English going on, for even one minute is worth something
when the time is so limited.
“I hope this is not asking too much; it is for all, at any
rate....

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PTS: 1 REF: p. 6 - Poverty OBJ: Cognitive Level: Application

PTS: 1 REF: p. 6 - Poverty

PTS: 1 REF: p. 7 - Homelessness

PTS: 1 REF: p. 7 - Homelessness

PTS: 1 REF: p. 8 - Homelessness

9. Psychological problems most often identified among homeless children are:

PTS: 1 REF: p. 8 - Homelessness

PTS: 1 REF: p. 11 - Violence

PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 13 - Cultural Considerations box OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 12 - Infant Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 12 - Child Mortality

PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 13 - Child Mortality OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 9 - Migrant Farm Workers OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 15 - Family-Centered Care

PTS: 1 REF: p. 16 - Box 1-3

PTS: 1 REF: p. 15 - Family-Centered Care

PTS: 1 REF: p. 1 - Family-Centered Care OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 17 - Advocate

PTS: 1 REF: p. 15 - Family-Centered Care

PTS: 1 REF: p. 16 - Roles of the Pediatric Nurse

27. Atraumatic care refers to:

PTS: 1 REF: p. 16 - A traumatic Care

PTS: 1 REF: p. 16 - A traumatic Care

29. Which of the following best describes differentiated practice?

PTS: 1 REF: p. 20 - Differentiated Practice Roles

PTS: 1 REF: p. 21 - Advanced Practice Roles OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 17 - Advocate

PTS: 1 REF: p. 18 - Educator OBJ: Cognitive Level: Knowledge

33. An appropriate method for teaching preschool children would be:

PTS: 1 REF: p. 18 - Educator

34. Adolescents learn best when they:

PTS: 1 REF: p. 19 - Educator

PTS: 1 REF: p. 19 - Educator OBJ: Cognitive Level: Knowledge

36. Affective learning activities would include:

PTS: 1 REF: p. 19 - Educator OBJ: Cognitive Level: Knowledge

37. Psychomotor learning activities include:

PTS: 1 REF: p. 19 - Educator OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 20 - Manager/Leader OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 20 - Manager/Leader OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 21 - Pediatric Nurse Practitioner OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 22 - Case Manager OBJ: Cognitive Level: Knowledge

42. Critical pathways are designed to indicate:

PTS: 1 REF: p. 22 - Case Manager OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 22 - Case Manager OBJ: Cognitive Level: Knowledge

PTS: 1 REF: p. 14 - Child Mortality OBJ: Cognitive Level: Application