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2) The nurse is assessing a patient's risk factors for disease at an annual physical examination.
Which question would the nurse ask to assess lifestyle risk factors?
A) "Does your neighborhood have parks and sidewalks?"
B) "Tell me about the health of your parents."
C) "What is the highest level of education that you completed?"
D) "How would you describe your diet?"
Answer: D
Explanation: A) Risk factors emerge from a number of sources. One is the genetic blueprint
provided to each of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions
about diet, exercise, smoking, and other variables that influence health. Social determinants of
health are factors related to where one lives, educational level, income, availability of fresh food,
public transportation, and a number of other considerations that can affect health.
B) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
C) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
D) Risk factors emerge from a number of sources. One is the genetic blueprint provided to each
of us at birth, and another is lifestyle factors. Lifestyle factors reflect decisions about diet,
exercise, smoking, and other variables that influence health. Social determinants of health are
factors related to where one lives, educational level, income, availability of fresh food, public
transportation, and a number of other considerations that can affect health.
Page Ref: 9
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.2 Describe characteristics of
and risk factors associated with health and illness. | QSEN Competencies: I.B.10 Engage patients
or designated surrogates in active partnerships that promote health, safety and well-being, and
self-care management | AACN Essential Competencies: IX. 1. 1. Conduct comprehensive and
focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental
assessments of health and illness parameters in patients, using developmentally and culturally
appropriate approaches
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

2
Copyright © 2019 Pearson Education, Inc.
3) The occupational health nurse is assessing a manufacturing plant for chemical agents that may
cause disease in the employees. The nurse should be alert for:
A) stress levels.
B) helminths.
C) radiation.
D) lead.
Answer: D
Explanation: A) Endogenous disease etiologies arise from within the body. Examples are
abnormal immune reactions, gene mutations, coagulation defects, stress, and metabolic
abnormalities.
B) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of infectious etiologic agents are bacteria,
viruses, fungi, and helminths.
C) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of physical etiologic agents are extremes in
environmental temperatures, radiation, trauma, and electricity.
D) Etiologic agents may be exogenous, that is, arising from the external environment, such as
chemical, physical, and infectious agents. Examples of chemical etiologic agents are alcohol,
lead, mercury, air pollutants, carbon monoxide, pesticides, and adverse effects of medications.
Page Ref: 10
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX. 1. 1.
Conduct comprehensive and focused physical, behavioral, psychological, spiritual,
socioeconomic, and environmental assessments of health and illness parameters in patients,
using developmentally and culturally appropriate approaches
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

3
Copyright © 2019 Pearson Education, Inc.
4) A patient has been diagnosed with idiopathic pulmonary fibrosis. The nurse explains to the
patient that idiopathic means:
A) the disease is inherited.
B) the cause is unknown.
C) it was caused by an error in care.
D) the disease is secondary to another illness.
Answer: B
Explanation: A) A disease that is inherited is a genetic or hereditary disorder.
B) When the cause of a disease cannot be determined, its etiology is said to be idiopathic.
C) The etiology of conditions that are caused unintentionally by a treatment, a diagnostic
procedure, or an error caused by a healthcare provider are called iatrogenic.
D) A condition that is caused by another disease is called a secondary disorder.
Page Ref: 10
Cognitive Level: Understanding
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.7.
Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality,
patient preferences, and health literacy considerations to foster patient engagement in their care
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

4
Copyright © 2019 Pearson Education, Inc.
5) The nurse is documenting the assessment findings from a patient being seen in the clinic.
Which of the following does the nurse document as a subjective finding?
A) Nausea
B) Breath sounds
C) Fever
D) Skin color
Answer: A
Explanation: A) A symptom is a subjective sensation that is perceived by the affected individual
but not observable by the person examining the individual. Examples of symptoms include pain,
nausea, dyspnea, and numbness. A sign is an objective indication of disease that is observable by
the person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
B) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
C) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
D) A symptom is a subjective sensation that is perceived by the affected individual but not
observable by the person examining the individual. Examples of symptoms include pain, nausea,
dyspnea, and numbness. A sign is an objective indication of disease that is observable by the
person conducting a physical assessment. Examples of signs include abnormal heart or lung
sounds, rash, fever, a change in the respiratory or heart rate, sluggish or absent pupil reaction to
light, and changes in skin color.
Page Ref: 10
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Assessment | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX. 1. 1.
Conduct comprehensive and focused physical, behavioral, psychological, spiritual,
socioeconomic, and environmental assessments of health and illness parameters in patients,
using developmentally and culturally appropriate approaches
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

5
Copyright © 2019 Pearson Education, Inc.
6) How should the nurse respond when a patient asks the difference between acute and chronic
hip pain?
A) "An acute illness develops over a longer period of time than a chronic one."
B) "A chronic illness is more serious than an acute illness."
C) "A chronic illness is enduring while an acute illness is short term."
D) "A chronic illness is life threatening while an acute illness is not."
Answer: C
Explanation: A) An acute injury or disease is one that appears quickly; a chronic condition has
an enduring quality with lasting implications. An important point is that neither of these terms
relates to severity or degree of injury or disease. For example, when an individual sprains an
ankle, an acute injury, the injury is sudden but might not have significant lasting implications. In
contrast, with a chronic disease, there are several states that may be enduring and lasting (such as
a mild case of osteoarthritis) but without significant impairment of functional ability.
B) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
C) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
D) An acute injury or disease is one that appears quickly; a chronic condition has an enduring
quality with lasting implications. An important point is that neither of these terms relates to
severity or degree of injury or disease. For example, when an individual sprains an ankle, an
acute injury, the injury is sudden but might not have significant lasting implications. In contrast,
with a chronic disease, there are several states that may be enduring and lasting (such as a mild
case of osteoarthritis) but without significant impairment of functional ability.
Page Ref: 11
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.A.1. Demonstrate
knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3.
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management and nursing management
across the health-illness continuum, across lifespan, and in all healthcare settings
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

6
Copyright © 2019 Pearson Education, Inc.
7) A nurse researcher involved in epigenomics is studying:
A) the role of specific genes.
B) the function of groups of genes in mediating physiologic function.
C) genetic variations and modifications that influence a particular cell.
D) the origin of the structural and functional events leading to disease.
Answer: C
Explanation: A) Through genetics, the role of specific genes is studied. This study involves
examining how genetic variations are passed through familial inheritance.
B) Genomics refers to the study of the function of groups of genes in terms of mediating
physiologic function. Genomics studies how an inherited genetic trait, such as sickle cell trait,
influences the likelihood that an individual will develop sickle cell disease.
C) The study of all genetic variations or modifications that have influenced a particular cell is
referred to as epigenomics. The focus is on the broader picture in terms of studying a complete
set of modifications to cellular DNA.
D) The pathogenesis of a disease refers to origin of, or the underlying mechanisms responsible
for, the clinical manifestations of that disease. Pathogenesis is the origin of the sequence of
events to structural and/or functional alterations in cells, tissues, or organs resulting in disease.
Page Ref: 10-11
Cognitive Level: Understanding
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: III.B. 1 Participate
effectively in appropriate data collection and other research activities | AACN Essential
Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process
and models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

7
Copyright © 2019 Pearson Education, Inc.
8) When planning a program to educate the community about healthy nutrition, the community
health nurse should tell adults to consume:
A) 100% of grain intake as whole grains.
B) at least 3.5 cups of fruits and vegetables each day.
C) more highly pigmented fruits and vegetables.
D) 3 to 5 servings of dairy each day.
Answer: C
Explanation: A) At least half of our daily intake of grains should be whole grains. The words
"whole wheat" as the first ingredient indicates a whole grain product. Other good choices are
common foods as oatmeal and popcorn. Less familiar grains such as quinoa or whole-grain
couscous could also be included.
B) Adults are advised to consume at least 4.5 cups of fruits and vegetables daily for a variety of
vitamins, minerals, phytochemicals, and fiber.
C) The more highly pigmented the fruits and vegetables are, the better. Beets, spinach, squash,
and berries are all good picks.
D) Most Americans should consume two to three servings of low-fat dairy foods such as milk,
yogurt, or low-fat cheese daily.
Page Ref: 12
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | AACN Essential Competencies: VII. 11. Participate in clinical prevention and
population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness
and equity
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

8
Copyright © 2019 Pearson Education, Inc.
9) When developing a care plan to teach a patient with hypertension about sodium intake, the
nurse should include limiting sodium intake to:
A) 2,300-2,500 mg/day.
B) 2,000-2,300 mg/day.
C) 1,500-2,000 mg/day.
D) less than 1,500 mg/day.
Answer: D
Explanation: A) Sodium should be limited to 2,300 mg/day for individuals younger than 51
years of age and less than 1,500 mg/day for those 51 years of age or older, African Americans,
and individuals with hypertension, diabetes, or chronic kidney disease.
B) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
C) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
D) Sodium should be limited to 2,300 mg/day for individuals younger than 51 years of age and
less than 1,500 mg/day for those 51 years of age or older, African Americans, and individuals
with hypertension, diabetes, or chronic kidney disease.
Page Ref: 13
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.3 Outline the structure of this
program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | AACN Essential Competencies: IX.7. Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

9
Copyright © 2019 Pearson Education, Inc.
10) Which of the following statements describes the role of a nurse involved in epidemiology?
A) The nurse studies an individual's risk for disease.
B) The nurse provides care to individuals with certain diseases.
C) The nurse studies the distribution of disease in a population.
D) The nurse provides care to a population.
Answer: C
Explanation: A) Epidemiology is broadly defined as the study of how disease is distributed in
populations and identification of the factors influencing the distribution.
B) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
C) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
D) Epidemiology is broadly defined as the study of how disease is distributed in populations and
identification of the factors influencing the distribution.
Page Ref: 14
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII.1 Assess protective and predictive factors, including
genetics, which influence the health of individuals, families, groups, communities and
populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

10
Copyright © 2019 Pearson Education, Inc.
11) Which statement represents the epidemiology nurse's calculation of the incidence of asthma?
A) There were 10 new cases of asthma diagnosed in adults ages 24 to 65 years in the past 12
months in Centerville.
B) There were a total of 3,600 people with a diagnosis of diabetes in Centerville in 2015.
C) There were 2 people diagnosed with Lyme disease in Centerville last year.
D) There were 20 cases of opioid overdose in adults ages 18 to 24 years in Centerville.
Answer: A
Explanation: A) Incidence is the number of new cases of a condition within a defined period and
for a defined population, such as the number of individuals who experienced a spinal cord injury
within the past 12 months in the United States. Other defined populations could include adults,
children, and athletes. Incidence provides a sense of frequency of occurrence in a particular
group or population. Prevalence is the number of individuals of a defined population who
already have a disease or condition, such as the number of adults in the United States with a
spinal cord injury.
B) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
C) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
D) Incidence is the number of new cases of a condition within a defined period and for a defined
population, such as the number of individuals who experienced a spinal cord injury within the
past 12 months in the United States. Other defined populations could include adults, children,
and athletes. Incidence provides a sense of frequency of occurrence in a particular group or
population. Prevalence is the number of individuals of a defined population who already have a
disease or condition, such as the number of adults in the United States with a spinal cord injury.
Page Ref: 14
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Assessment | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII. 11. Participate in clinical prevention and population-
focused interventions with attention to effectiveness, efficiency, cost-effectiveness and equity
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

11
Copyright © 2019 Pearson Education, Inc.
12) In developing a plan for teaching community health nurses about the role of the nurse in
epidemiology, the epidemiology nurse should include:
A) diagnosing the cause of a disease.
B) treating the disease.
C) evaluating therapeutic measures.
D) reducing risk factors for disease.
Answer: C
Explanation: A) The objectives of epidemiology are to identify the cause of the disease and the
risk factors, to determine the extent of the disease in the community, to study the natural history
and the prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
B) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
C) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
D) The objectives of epidemiology are to identify the cause of the disease and the risk factors, to
determine the extent of the disease in the community, to study the natural history and the
prognosis of the disease, to evaluate both existing and newly developed preventive and
therapeutic measures and modes of healthcare delivery, and to provide the basis for developing
public policy related to a variety of measures.
Page Ref: 14
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: II.A.2 Describe scopes of practice and roles of health care team members
| AACN Essential Competencies: VII.1 Assess protective and predictive factors, including
genetics, which influence the health of individuals, families, groups, communities and
populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

12
Copyright © 2019 Pearson Education, Inc.
13) When planning community health promotion and prevention programs, the nurse should be
aware that the leading cause of death in the United States is:
A) accidents.
B) suicide.
C) heart disease.
D) cancer.
Answer: C
Explanation: A) The leading causes of death in the United States in 2015 were: heart disease
614,348; cancer (all forms) 591,699; chronic lower respiratory diseases 147,101; accidents
(unintentional injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease
93,541; diabetes 76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and
nephrosis 48,146; and intentional self-harm (suicide) 42,773.
B) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
C) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
D) The leading causes of death in the United States in 2015 were: heart disease 614,348; cancer
(all forms) 591,699; chronic lower respiratory diseases 147,101; accidents (unintentional
injuries) 136,053; stroke (cerebrovascular diseases) 133,103; Alzheimer disease 93,541; diabetes
76,488; influenza and pneumonia 55,227; nephritis, nephrotic syndrome, and nephrosis 48,146;
and intentional self-harm (suicide) 42,773.
Page Ref: 15
Cognitive Level: Understanding
Client Need & Sub: Health Promotion and Disease Prevention
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | AACN Essential
Competencies: VII.1 Assess protective and predictive factors, including genetics, which
influence the health of individuals, families, groups, communities and populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 4: Associate the study epidemiology and the leading indicators of
morbidity and mortality in the U.S.

13
Copyright © 2019 Pearson Education, Inc.
14) Which information about risk factors should the school nurse use when developing a
program to reduce modifiable risk factors in high school students?
A) Sickle cell anemia is an inherited disorder.
B) Heart disease develops at an earlier age in men.
C) Many high school students do not get enough physical activity.
D) Certain ethnic variables increase the risk for chronic disease.
Answer: C
Explanation: A) Age, gender, and racial/ethnic differences are unmodifiable risk factors for
many diseases.
B) Age, gender, and racial/ethnic differences are unmodifiable risk factors for many diseases.
C) The four most important modifiable health risk behaviors are physical inactivity, poor
nutrition, tobacco use, and excessive alcohol consumption. Only 33% of U.S. high school
students participate in daily physical education classes.
D) Age, gender, and racial/ethnic differences are unmodifiable risk factors for many diseases.
Page Ref: 15-16
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | AACN Essential
Competencies: VII.1 Assess protective and predictive factors, including genetics, which
influence the health of individuals, families, groups, communities and populations
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

14
Copyright © 2019 Pearson Education, Inc.
15) A woman with type 1 diabetes is being seen for her first prenatal examination. Which
information should the nurse include in the woman's care plan?
A) Teaching the signs and symptoms of preeclampsia
B) Explaining the fetal risk of microsomia
C) Discussing symptoms of placental abruption to report
D) Reinforcing that there will be no risk to the fetus
Answer: A
Explanation: A) Women who had type 1 or type 2 diabetes before becoming pregnant can have
a variety of adverse fetal and maternal outcomes, such as increased risk for preeclampsia,
hypertension during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery,
macrosomia (very large baby), hypoglycemia, fetal death, and infant death.
B) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
C) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
D) Women who had type 1 or type 2 diabetes before becoming pregnant can have a variety of
adverse fetal and maternal outcomes, such as increased risk for preeclampsia, hypertension
during pregnancy, cesarean delivery, miscarriage, birth defects, preterm delivery, macrosomia
(very large baby), hypoglycemia, fetal death, and infant death.
Page Ref: 16
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: I.B.10 Engage patients or designated surrogates in active partnerships
that promote health, safety and well-being, and self-care management | AACN Essential
Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age,
culture, spirituality, patient preferences, and health literacy considerations to foster patient
engagement in their care
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 2: Consider the characteristics of and risk factors associated with
health and illness.

15
Copyright © 2019 Pearson Education, Inc.
16) A nurse working on a busy medical unit has noticed an increase in the incidence of pressure
ulcers in the patient population. Which action demonstrates the principles of evidence-based
practice (EBP)?
A) Reviewing the literature for current best evidence pressure ulcer prevention
B) Reviewing the literature for informational articles on best methods to prevent pressure ulcers
C) Reviewing hospital policy and procedures to make sure they are being followed correctly
D) Reviewing patient charts to audit nursing interventions to prevent pressure ulcers
Answer: A
Explanation: A) EBP is "the conscientious, explicit and judicious use of current best evidence in
making decisions about the care of the individual patient. It means integrating individual clinical
expertise with the best available external clinical evidence from systematic research."
B) EBP should be based on research and best evidence and not informational articles.
C) Policy and procedures may not reflect the most current EBP. They should be reviewed to
determine if they are based on current best evidence.
D) Auditing nursing care is not an example of EBP.
Page Ref: 17
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.5 Explain the importance of
evidence-based practice. | QSEN Competencies: III.A. Demonstrate knowledge of basic
scientific methods and processes | AACN Essential Competencies: IX.8. Implement evidence-
based nursing interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

16
Copyright © 2019 Pearson Education, Inc.
17) Which action by the nurse shows an understanding of integrating evidence-based principles
into practice?
A) Creating a care plan and then presenting it to the patient
B) Making the best decisions for the patient
C) Seeking patient preferences about his care
D) Providing written information explaining the patient's care
Answer: C
Explanation: A) The process of implementing evidence into practice relies on melding clinical
expertise with existing research evidence in providing care that also respects the values and
preferences of the patient. Without acknowledging patient preferences and experience, the
healthcare provider could implement interventions supported by the literature but find a patient
who is not adhering to the recommendations because of different goals or values.
B) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
C) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
D) The process of implementing evidence into practice relies on melding clinical expertise with
existing research evidence in providing care that also respects the values and preferences of the
patient. Without acknowledging patient preferences and experience, the healthcare provider
could implement interventions supported by the literature but find a patient who is not adhering
to the recommendations because of different goals or values.
Page Ref: 17
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.5 Explain the importance of
evidence-based practice. | QSEN Competencies: III.A. Demonstrate knowledge of basic
scientific methods and processes | AACN Essential Competencies: IX.8. Implement evidence-
based nursing interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

17
Copyright © 2019 Pearson Education, Inc.
18) When developing a care plan for a patient with asthma, the nurse needs to understand which
pathophysiological subconcept?
A) Infection
B) Coagulation
C) Inflammation
D) Perfusion
Answer: C
Explanation: A) Asthma is a condition of reactive airway constriction, in which parts of the
respiratory tract are sensitive to allergens. In the presence of an environmental allergen, parts of
the respiratory tract constrict, restricting the flow of air into the lung. The reduction in air flow
leads to decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the
immune system, which releases inflammatory mediators. The resulting inflammation contributes
to the reduction of airflow.
B) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
C) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
D) Asthma is a condition of reactive airway constriction, in which parts of the respiratory tract
are sensitive to allergens. In the presence of an environmental allergen, parts of the respiratory
tract constrict, restricting the flow of air into the lung. The reduction in air flow leads to
decreases in the concentration of oxygen in the bloodstream. The allergen stimulates the immune
system, which releases inflammatory mediators. The resulting inflammation contributes to the
reduction of airflow.
Page Ref: 7
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Planning | Learning Outcome: 1.1 Define the conceptual basis for
and the language used in the study of pathophysiology. | QSEN Competencies: III.A.1.
Demonstrate knowledge of basic scientific methods and processes | AACN Essential
Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management and
nursing management across the health-illness continuum, across lifespan, and in all healthcare
settings
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 1: Recognize the conceptual basis for and the language used in the
study of pathophysiology.

18
Copyright © 2019 Pearson Education, Inc.
19) When the nurse teaches parents how transmitting the sickle cell trait to offspring influences
the development of sickle cell disease, the nurse is applying principles of:
A) genomics.
B) genetics.
C) epigenomics.
D) gene.
Answer: A
Explanation: A) Genomics refers to the study of the function of groups of genes in terms of
mediating physiologic function. Genomics explains how an inherited genetic trait, such as sickle
cell trait, influences the likelihood that an individual will develop sickle cell disease.
B) Genetics is the study of how gene variations are passed through familial inheritance.
C) Epigenomics is the study of all genetic variations or modifications that have influenced a
particular cell. The focus is on the broader picture in terms of studying a complete set of
modifications to cellular DNA.
D) Genes, made up of DNA, are the genetic material of inheritance within a cell.
Page Ref: 11
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 Outline the structure of
this program, including the pathogenesis and etiology of disease; the clinical manifestations of
disorders; how pathophysiology is linked to diagnosis and treatment; and the impact of genetics,
nutrition, and lifespan on health and illness. | QSEN Competencies: I.B.10 Engage patients or
designated surrogates in active partnerships that promote health, safety and well-being, and self-
care management | AACN Essential Competencies: IX.7. Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

19
Copyright © 2019 Pearson Education, Inc.
20) The nurse is reviewing literature to determine the death rate due to cardiovascular disease in
the United States. The nurse understands that the information he is seeking indicates:
A) morbidity.
B) mortality.
C) disability-adjusted life-years.
D) prevalence.
Answer: B
Explanation: A) Morbidity is defined as a departure from physiologic or psychologic well-being
and encompasses disease, injury, and disability.
B) Mortality is defined as the number of deaths in a given population.
C) Disability-adjusted life-years (DALYs) are defined as the years of potential life lost due to
premature mortality and the years of productive life lost due to disability for people living with
the health condition or its sequelae.
D) Prevalence is the number of individuals of a defined population who already have a disease or
condition.
Page Ref: 14-15
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: Nursing Process: Planning | Learning Outcome: 1.4 Describe the study of
epidemiology, and outline the leading indicators of morbidity and mortality in the United States.
| QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and
processes | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care
MNL Learning Outcome: LO 3: Relate how the key factors and basic principles that inform
pathophysiology impact health and illness.

20
Copyright © 2019 Pearson Education, Inc.
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“Very good, sir. Thank you, sir.”

Hans opened the door and went out, leaving it slightly

ajar. From the shadows beside it, the lads saw him
approach the sentry, who lounged on a stool by the
gate.

“Too hot in there to sleep,” remarked Hans. “I’m going

above to catch a breath of air.”

“Wish I could!” The sentry placed his rifle against the

wall. “This ship is an oven below-decks. Practically the
whole port watch has gone ashore. Just my bad luck to
be stuck down here.”

“Look at the size of that rat!” exclaimed the steward,

pointing down the prison corridor.

“Where?” Otto swung round toward the barred gate.

Hans immediately caught up the rifle and pressed the

muzzle against the man’s side. “One peep out of you,”
he muttered, “and I’ll give you a bellyful!”

Otto stared at him dazedly. Before he could decide 238

whether or not to make a move, Bill thrust the gag in
his mouth, while Osceola caught his wrists and lashed
them fast behind his back.

It took only a moment longer to tie up his ankles. Otto

was laid on the floor, and with Hans in the lead and
carrying the rifle, the three hurried down the passage
away from the gate.

239
 Chapter XVIII
THE FLYING FISH PLAYS ITS
PART

Hans led them up through the galleys and pantries into

the First Class Dining Saloon without encountering a
single soul. They went boldly up the main staircase to
the promenade deck, which seemed deserted. A small
figure hiding in the shadows ran up to them, and Charlie
gripped his friends’ hands.

“Never mind the thanks,” he whispered. “We’ve got to

work fast. There’s an armed seaman at the gangway
head. We must quiet him first. Then we’ll take the ship’s
boat that’s moored below.”

“Okay, boy.”

Without another word, Bill walked up to the gangway

sentry, who immediately brought his rifle to the present.

“There’s rust on that barrel,” growled Bill and held out 240
his hand. “I can see it even in this light.”

“But—but I think,” stammered the sentry, “that my

officer is mistaken!” He passed over the gun without
suspicion.
Immediately afterward, he found himself in the same
dilemma Otto had encountered ten minutes earlier. Tied
up and gagged with a handkerchief, he was deposited
behind a pile of deck chairs.

His captors wasted no further time. They ran down the

gangway and piled aboard the skiff moored to the
grating. Hans got out the single pair of oars, Osceola
unloosed the painter, and Bill, who seated himself
beside Charlie in the stern, steered their small craft
away from the ship. There were men on the Amtonia’s
bridge but they received no hail to return.

Bill looked about. Although there was no moon, the 241

brilliant starlight gave ample light for him to size up his
surroundings. He found that they were floating in a
large cove or harbor almost landlocked. The body of
water was eggshaped; perhaps a mile long by half that
distance in width. The shores were rocky, with black
patches of sandy beach. Beyond grew a dense forest,
except at one end of the bay, where twinkling lights
marked a small settlement. The outlet to the ocean was
narrow, and guarded by high cliffs. It was a perfect
retreat for the Baron and his pirates.

Charlie piped up in his boyish treble. “The Amtonia’s

absolutely hidden by those heads from any ship passing
up or down the coast. The harbor entrance makes a
right-angled turn half way to the sea. I heard Lieutenant
Brinkerhoff say that a warship passed the mouth, going
west, about eleven-thirty. The lookout on the head
signalled in. Brinkerhoff was laughing about it, I guess it
made him feel good.”

“Well, his break is ours now,” declared Bill. “And there’s

another one for us!”
He pointed to where the Flying Fish lay moored, with 242
her wings spread, a few hundred yards away.

“It’ll be hot as Tophet in her hull tonight! Row on, Hans.

We’re going over there to pay a visit. By the way, does
anyone know exactly where we are?”

“Yes, sir,” replied the man, “this harbor is on the coast of

Maine. Washington County, I think, sir—not very far
from Englishman’s Bay.”

“Good enough! What are those lights yonder?”

“You might call that our private Navy Yard, sir. It’s the
Baron’s shore base. He keeps a crew on duty there,
while the ships are at sea. There are storehouses, a
machine shop, the men’s quarters and a store. It’s ten
miles back to the railroad. He owns all the shore
acreage hereabouts. A high wire fence shuts in the
property from all outsiders. There are one or two big
estates up and down the coast, but the nearest house is
a good three miles away.”

“How are the roads?” 243

“There’s no road along the coast, sir. The one from the
base runs back to the little town on the railroad. It’s in
very bad condition, sir. There is no other way out.”

“Thank you, Hans. You’re a treasure-house of local

knowledge.”

“Thank you, sir. May I make a suggestion?”

“Fire away.”
“My brother, August, is deck watch aboard the Flying
Fish, sir. Usually, in port, only one man is kept aboard
her. August does not like this life. Like me, he was
shanghaied into it. Once with this outfit, there is no
getting away, unless by a miracle, like tonight, sir.
August speaks no English. May I ask him to join us?”

“By all means, Hans. It will save a lot of trouble. Offer

him what Mrs. Evans said she would give you. I will see
that it is paid.”

“Very good, sir. Thank you, sir.”

They were close to the converted submarine now. On 244

the narrow deck, abaft the motors a man was seated on
a camp chair, smoking. He stood up as the boat
approached.

Hans hailed him and for several minutes the two

brothers hurled harsh gutturals at each other. Bill
guessed them to be speaking a low Bavarian dialect of
German. He failed to understand a single word of what
they said.

“He wants me to thank you—he will come,” Hans

asserted presently.

“What a polite family you are—” chuckled Bill. “Let’s get

aboard.”

Fifteen minutes later those officers and men who had

remained on deck aboard the anchored pirate ship were
astonished to see the Flying Fish taxi down the harbor
and take the air. A few seconds later her tail lights
disappeared into the dark beyond the headlands.
Aboard the Amtonia orders were shouted, bells clanged,
and presently the whining howl of her siren awoke the
echoes of the night.

Half an hour passed. Bill, at the wheel of the Flying 245

Fish, leaned forward, his eyes focussed on a pinpoint of
light far below and about ten miles ahead of the
speeding airplane.

“There she is on a bet,” he said to Osceola, who was in

the other pilot’s seat.

“You mean the warship Charlie told us about? What

makes you so sure?”

“I’ve got a hunch, that’s all. Anyway, nothing but a

fishing boat or one of the little steamers that put in at
the small seaports along this part of the coast would be
so close to shore. That’s a big ship out there. I think I’m
right about her.”

Bill’s hunch was correct, as the two in the cockpit

presently saw.

“It’s the Stamford, or her twin!” he declared. “Uncle

Sam sure is on the job!”

Catching up with the cruiser, he circled her three times.

Then the Flying Fish darted ahead, landed and came to
rest half a mile beyond. By the time the warship hove to
beside them, Bill had a sea anchor out and was waiting
on the heaving deck. He held a megaphone in his hand.
Beside him, staring at the big cruiser, stood Osceola,
Charlie, Hans and August.

“What craft is that?” came a hail from the warship’s 246

bridge.
“The convertible submarine-seaplane, Flying Fish,
Midshipman William Bolton in command,” Bill yelled
back. “She was part of von Hiemskirk’s pirate outfit. She
belongs to Uncle Sam now. We captured her less than
an hour ago. Are you the Stamford?”

“You’ve guessed it!” spoke a jubilant voice. “Commander

Brown speaking,” it went on, “are you the chaps who
sent out that wireless?”

“Yes, sir.”

“Congratulations, Mr. Bolton. Where is the Amtonia?”

“At anchor in a small harbor a few miles up the coast,

sir. One of her propellers was shot off in the scrap the
other day. She hasn’t got steam up, or didn’t have,
when we left—so I guess she’s still there.”

“Good! Take off at once and lead us to her.”

“Aye, aye, sir. There’s plenty of water but the channel to 247
the harbor is a narrow one between twin heads. You’ll
have to be careful.”

“Thank you, Mr. Bolton. Any other suggestions?”

“Yes, sir. Please wireless to the state constabulary to

guard the road from Twin Head Harbor to Clayton.
That’s the only way von Hiemskirk and his crew can
escape by land.”

“We’ll attend to it at once,” said the Commander. “Cut

along now. We’ll follow you, so don’t get too far ahead.”

“Aye, sir,” said Bill, and sent Hans forward to haul in the
sea anchor.
The first pale rays of summer dawn were brightening
sea and land when the Stamford navigated the entrance
between Twin Heads and pushed her wicked snout into
the harbor. At the same instant, Bill landed the Flying
Fish on the calm water.

Through the cockpit windows Bill saw that the Amtonia

was raising her anchors.

“Von Hiemskirk was all set to run for it,” he said to the 248
chief.

“But he wasn’t quite quick enough,” grinned Osceola.

“Next stop, Atlanta, for that bunch. There’s mighty little
pirating to be done in a federal prison!”

“They’re hauling down the Jolly Roger!” cried Bill. “Well,

that cuts it. Somebody will be sending a boat over here
after awhile. Let’s see if we can rustle some chow in the
meantime. I’m starved!”

The boat came alongside shortly after the five aboard

the Flying Fish had finished doing justice to a very
substantial breakfast. And all five were on deck when
the ensign in charge came over the side.

“Mr. Bolton?” inquired the young officer, as Bill stepped

forward.

“Himself,” smiled Bill.

“I’m Pierce, of the Stamford.” The two shook hands.

“Commander Brown’s compliments,” he continued after 249

Bill had introduced the quartet, “he wishes you to come
aboard the Amtonia. We wirelessed the news, of course,
and have just received a message of thanks addressed
to you, signed by the President. You are to go to
Washington, just as soon as this business here is
cleaned up. In fact, the President wants to meet the five
of you.”

“I bet Bill will get the Congressional Medal!” shrilled

Charlie.

“I shouldn’t be surprised,” smiled Pierce. “Gosh!” he

exploded, “this is a big thing you fellows have put over!”

“But Bill was the brains of it,” said Osceola.

“Without everybody’s help,” said Bill, “we never should

have pulled it off.”

“Cut the argument,” laughed Ensign Pierce. “The skipper

is waiting, and so are several hundred delighted
passengers.”

“That’s just it,” protested Bill, “I’d rather be shot than

face that mob!”

“Not me!” said Charlie. “Gee, it’ll be swell! Because I 250

was the youngest on board, everybody took pleasure in
jumping on me. Now I can tell them all where to shove
off! Let’s go!”

THE END

Those who read and enjoyed this book and the one
preceding it, (Bill Bolton—Flying Midshipman) will want
to read the next of this series, Bill Bolton and The
Hidden Danger.
 Transcriber’s Notes

Copyright notice provided as in the original—this e-text

is public domain in the country of publication.
Silently corrected palpable typos; left non-standard (or
amusing) spellings and dialect unchanged.
In the text versions, delimited italics text in
_underscores_ (the HTML version reproduces the font
form of the printed book.)
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