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Test Bank for Introduction to Critical Care Nurs-
ing, 8th Edition, Mary Lou Sole, Deborah Klein
Marthe Moseley
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Chapter 01: Overview of Critical Care Nursing
Sole: Introduction to Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. Which of the following professional organizations best supports critical care nursing practice?
a. American Association of Critical-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of Critical Care Medicine
ANS: A
The American Association of Critical-Care Nurses is the specialty organization that supports
and represents critical care nurses. The American Heart Association supports cardiovascular
initiatives. The American Nurses Association supports all nurses. The Society of Critical Care
Medicine represents the multiprofessional critical care team under the direction of an
intensivist.
DIF: Cognitive Level: Knowledge
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: NCLEX: Safe and Effective Care Environment
2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is
interested in certification. Which credential would be most applicable for her to seek?
a. ACNPC
b. CCNS
c. CCRN
d. PCCN
ANS: C
The CCRN certification is appropriate for nurses in bedside practice who care for critically ill
patients. The ACNPC certification is for acute care nurse practitioners. The CCNS
certification is for critical care clinical nurse specialists. The PCCN certification is for staff
nurses working in progressive care, intermediate care, or step-down unit settings.
DIF: Cognitive Level: Application
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A

3. What is the main purpose of certification for critical care nursing?
a. To assure the consumer that critical nurses will not make a mistake.
b. To help prepare the critical care nurse for graduate school.
c. To assist in promoting magnet status for a facility.
d. To validate a nurse’s knowledge of critical care nursing.
ANS: D
Certification assists in validating knowledge of the field, promotes excellence in the
profession, and helps nurses to maintain their knowledge of critical care nursing. Certification
helps to assure the consumer that the nurse has a minimum level of knowledge; however, it
does not ensure that care will be mistake-free. Certification does not prepare one for graduate
school; however, achieving certification demonstrates motivation for achievement and
professionalism. Magnet facilities are rated on the number of certified nurses; however, that is
not the purpose of certification.
DIF: Cognitive Level: Analysis
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
4. What is the focus of the synergy model of practice?
a. Allowing unrestricted visiting for the patient 24 hours each day.
b. Providing holistic and alternative therapies.
c. Considering the needs of patients and their families, which drives nursing
competency.
d. Addressing the patients’ needs for energy and support.
ANS: C
The synergy model of practice states that the needs of patients and families influence and
drive competencies of nurses. Nursing practice based on the synergy model would involve
tailored visiting to meet the patient’s and family’s needs and application of alternative
therapies if desired by the patient, but that is not the primary focus of the model.
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
5. The family of your critically ill patient tells you that they have not spoken with the physician
in over 24 hours and they have some questions that they want clarified. During morning
rounds, you convey this concern to the attending intensivist and arrange for her to meet with
the family at 4:00 PM in the conference room. Which competency of critical care nursing
does this represent?
a. Advocacy and moral agency in solving ethical issues
b. Clinical judgment and clinical reasoning skills
c. Collaboration with patients, families, and team members
d. Facilitation of learning for patients, families, and team members
ANS: C
Although one might consider that all of these competencies are being addressed,
communication and collaboration with the family and physician best exemplify the
competency of collaboration.

6. The AACN Standards for Acute and Critical Care Nursing Practice uses what framework to
guide critical care nursing practice?
a. Evidence-based practice
b. Healthy work environment
c. National Patient Safety Goals
d. Nursing process
ANS: D
The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing
process as applied to critically ill patients: collect data, determine diagnoses, identify expected
outcomes, develop a plan of care, implement interventions, and evaluate care. AACN
promotes a healthy work environment, but this is not included in the Standards. The Joint
Commission has established National Patient Safety Goals, but these are not the AACN
Standards.
DIF: Cognitive Level: Understand
7. The charge nurse is responsible for making the patient assignments on the critical care unit.
She assigns the experienced, certified nurse to care for the acutely ill patient diagnosed with
sepsis who also requires continuous renal replacement therapy and mechanical ventilation.
She assigns the nurse with less than 1 year of experience to two patients who are more stable.
This assignment reflects implementation of what guiding framework?
a. Crew resource management model
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. Synergy model of practice
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy
model notes that the nurse competencies are matched to the patient characteristics. Crew
resource management concepts related to team training, National Patient Safety Goals are
specified by The Joint Commission to promote safe care but do not incorporate the synergy
model. The Quality and Safety Education for Nurses initiative involves targeted education to
undergraduate and graduate nursing students to learn quality and safety concepts.
8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven
by achieving what goal?
a. Maintaining a healthy work environment.
b. Providing care from a multiprofessional team under the direction of a critical care
physician.
c. Effectively meeting the needs of critically ill patients and families.

d. Creating respectful, healing, and humane environments.
ANS: C
The AACN vision is a healthcare system driven by the needs of critically ill patients and
families where critical care nurses make their optimum contributions. AACN promotes
initiatives to support a healthy work environment as well as respectful and healing
environments, but that is not the organization’s vision. The SCCM promotes care from a
multiprofessional team under the direction of a critical care physician.
9. What is the most important outcome of effective communication?
a. Demonstrating caring practices to family members.
b. Ensuring that patient teaching is provided
c. Meeting the diversity needs of patients.
d. Reducing patient errors.
ANS: D
Many errors are directly attributed to faulty communication. Effective communication has
been identified as an essential strategy to reduce patient errors and resolve issues related to
patient care delivery. Communication may demonstrate caring practices, be used for
patient/family teaching, and address diversity needs; however, the main outcome of effective
communication is patient safety.
OBJ: Describe quality and safety initiatives related to critical care nursing.
10. The nurse is caring for a critically ill patient whose urine output has been low for 2
consecutive hours. After a thorough patient assessment, you call the primary care provider
with the following report.
Dr. Smith, I’m calling about Mrs. P., your 65-year-old patient in CCU 10. Her urine output
for the past 2 hours totaled only 40 mL. She arrived from surgery to repair an aortic
aneurysm 4 hours ago and remains on mechanical ventilation. In the past 2 hours, her heart
rate has increased from 80 to 100 beats per minute and her blood pressure has decreased
from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per
hour. Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her
urine is concentrated. Her BUN and creatinine levels have been stable and in normal range.
Her abdominal dressing is dry with no indication of bleeding. My assessment suggests that
Mrs. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a
fluid challenge. Using the SBAR model for communication, the information the nurse gives
about the patient’s history and vital signs is appropriate for what part of the model?
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: B

The history and vital signs are part of the background. Information regarding the low urine
output is the situation. Information regarding possible hypovolemia is part of the nurse’s
assessment, and the suggestion for fluids is the recommendation.
DIF: Cognitive Level: Understand
TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment
11. The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s
living will to the hospital, which identifies the patient’s wishes regarding health care. The
nurse discusses the contents of the living will with the patient’s physician. This is an example
of implementation of which of the AACN Standards of Professional Performance?
a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: B
Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient
and family. The example does not relate to acquiring knowledge, promoting patient safety, or
using research in practice.
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
12. Which of the following assists the critical care nurse in ensuring that care is appropriate and
based on research?
a. Clinical practice guidelines
b. Computerized physician order entry
c. Consulting with advanced practice nurses
d. Implementing Joint Commission National Patient Safety Goals
ANS: A
Clinical practice guidelines are being implemented to ensure that care is appropriate and based
on research. Some physician order entry pathways, but not all, are based on research
recommendations. Some advanced practice nurses, but not all, are well versed in evidence-
based practices. The National Patient Safety Goals are recommendations to reduce errors
using evidence-based practices.
13. Comparing the patient’s current (home) medications with those ordered during hospitalization
and communicating a complete list of medications to the next care provider when the patient
is transferred within an organization or to another setting are strategies toward best achieving
what patient related goal?
a. Improving accuracy of patient identification.
b. Preventing errors related to look-alike and sound-alike medications.

c. Reconciling medications across the continuum of care.
d. Reducing harms associated with administration of anticoagulants.
ANS: C
These are steps recommended in the National Patient Safety Goals to reconcile medications
across the continuum of care. Improving accuracy of patient identification is another National
Patient Safety Goal. Preventing errors related to look-alike and sound-alike medications is
done to improve medication safety, not medication reconciliation. Reducing harms associated
with administration of anticoagulants is another National Patient Safety Goal.
DIF: Cognitive Level: Comprehension
14. As part of nursing management of a critically ill patient, orders are written to keep the head of
the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess
readiness to wean from mechanical ventilation, and implement oral care protocols every 4
hours. These interventions are done as a group to reduce the risk of ventilator-associated
pneumonia. This group of evidence-based interventions is often referred to using what term?
a. Bundle of care.
b. Clinical practice guideline.
c. Patient safety goal.
d. Quality improvement initiative.
ANS: A
A group of evidence-based interventions done as a whole to improve outcomes is termed a
bundle of care. This is an example of the ventilator bundle. Oftentimes these bundles are
derived from clinical practice guidelines and are monitored for compliance as part of quality
improvement initiatives. At some point, these may become part of patient safety goals.
15. A nurse who works in an intermediate care unit has experienced high nursing turnover. The
nurse manager is often considered to be an autocratic leader by staff members and that
leadership style is contributing to turnover. The nurse asks to be involved in developing new
guidelines to prevent pressure ulcers in the patient population. The nurse manager suggests
that the nurse has not yet had enough experience to be on the prevention task force. This
situation and setting is an example of what form of ineffective leadership?
a. Creating a barrier to inter-staff communication.
b. Supporting a work environment that is unhealthy.
c. Displaying ineffective decision making.
d. Demonstrating nursing practice that is not evidence-based.
ANS: B

These are examples of an unhealthy work environment. A healthy work environment values
communication, collaboration, and effective decision making. It also has authentic leadership.
It is not an example of handoff communication, which is communication that occurs to
transition patient care from one staff member to another. Neither does it relate to ineffective
decision making. As a nurse, you can still implement evidence-based practice, but your
influence in the unit is limited by the unhealthy work environment.
16. Which of the following statements describes the core concept of the synergy model of
practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence
care.
d. Unique needs of patients and their families influence nursing competencies.
ANS: D
The synergy model of practice is care based on the unique needs and characteristics of the
patient and family members. Although critical care certification is based on the synergy
model, the model does not specifically address certification. Inclusion of family members into
the daily rounds is an example of implementation of the synergy model. With the focus on
patients and family members with nurse interaction, the synergy model does not address
physician collaboration.
MSC: NCLEX: Psychosocial Integrity
17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle is
said to demonstrate what focus?
a. Becoming a moral advocate.
b. Facilitating all forms of learning.
c. Responding to diversity.
d. Using effective clinical judgment.
ANS: C
Response to diversity considers all of these aspects when planning and implementing care. A
moral agent helps resolve ethical and clinical concerns. Consideration of these factors does
not necessarily facilitate learning. Clinical judgment uses other factors as well.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following is a National Patient Safety Goal? (Select all that apply.)

a. Accurately identify patients.
b. Eliminate use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of healthcare-acquired infection.
ANS: A, C, D
All except for eliminating use of restraints are current National Patient Safety Goals.
Hospitals have policies regarding use of restraints and are attempting to reduce the use of
restraints; however, this is not a National Patient Safety Goal.
2. Which of the following is (are) official journal(s) of the American Association of Critical-
Care Nurses? (Select all that apply.)
a. American Journal of Critical Care
b. Critical Care Clinics of North America
c. Critical Care Nurse
d. Critical Care Nursing Quarterly
ANS: A, C
American Journal of Critical Care and Critical Care Nurse are two official AACN
publications. Critical Care Clinics and Critical Care Nursing Quarterly are not AACN
publications.
3. What were identified as the first critical care units? (Select all that apply.)
a. Burn units.
b. Coronary care units
c. Recovery rooms.
d. Neonatal intensive care units.
e. High-risk OB units.
ANS: B, C
Recovery rooms and coronary care units were the first units designated to care for critically ill
patients. Burn, high risk OB and neonatal intensive care units were established as specialty
units evolved.
DIF: Cognitive Level: Knowledge OBJ: Define critical care nursing.
4. Which of the following nursing activities demonstrates implementation of the AACN
Standards of Professional Performance? (Select all that apply.)
a. Attending a meeting of the local chapter of the American Association of Critical-
Care Nurses in which a continuing education program on sepsis is being taught
b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs
of the patient and family

c. Participating on the unit’s nurse practice council
d. Posting an article from Critical Care Nurse on management of venous
thromboembolism for your colleagues to read
e. Using evidence-based strategies to prevent ventilator-associated pneumonia
ANS: A, B, C, D, E
All answers are correct. Attending a program to learn about sepsis—Acquires and maintains
current knowledge and competency in patient care. Collaborating with pastoral services—
Collaborates with the healthcare team to provide care in a healing, humane, and caring
environment. Posting information for others—Contributes to the professional development of
peers and other healthcare providers. Nurse practice council—Provides leadership in the
practice setting. Evidence-based practices—Uses clinical inquiry in practice.
5. Which scenarios contribute to effective handoff communication at change of shift? (Select all
that apply.)
a. The nephrology consultant physician is making rounds and asks the nurse to
provide an update on the patient’s status and assist in placing a central line for
hemodialysis.
b. The noise level is high because twice as many staff members are present and
everyone is giving report in the nurse’s station.
c. The unit has decided to use a standardized checklist/tool for change-of-shift reports
and patient transfers.
d. Both the off-going and the oncoming nurses conduct a standardized report at the
patient’s bedside and review key assessment findings.
e. The off-going nurse is giving the patient medications at the same time as giving
handoff report to the oncoming nurse.
ANS: C, D
A reporting tool and bedside report improve handoff communication by ensuring standardized
communication and review of assessment findings. Conducting report at the bedside also
reduces noise that commonly occurs at the nurse’s station during a change of shift. The
nephrologist has created an interruption that can impede handoff with the next nurse.
Likewise, noise in the nurse’s station can cause distractions that can impair concentration and
listening. Giving medications at the same time as handoff report could lead to serious errors
both in medication administration and in the report itself.
6. Which strategy is important to addressing issues associated with the aging workforce? (Select
all that apply.)
a. Allowing nurses to work flexible shift durations
b. Encouraging older nurses to transfer to an outpatient setting that is less stressful
c. Hiring nurse technicians that are available to assist with patient care, such as
turning the patient
d. Developing a staffing model that accurately reflects the unit’s needs.

e. Remodeling patient care rooms to include devices to assist in patient lifting
ANS: A, C, D
Modifying the work environment to reduce physical demands is one strategy to assist the
aging workforce. Examples include overhead lifts to prevent back injuries. Twelve-hour shifts
can be quite demanding; therefore, allowing nurses flexibility in choosing shifts of shorter
duration is a good option as well. Adequate staffing, including non-licensed assistive
personnel, to help with nursing and non-nursing tasks is helpful. Encouraging experienced,
knowledgeable critical care nurses to leave the critical care unit is not wise as the unit loses
the expertise of this group.
OBJ: Identify current trends and issues in critical care nursing. TOP: Nursing Process Step: N/A
7. Which of the following strategies will assist in creating a healthy work environment for the
critical care nurse? (Select all that apply.)
a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
b. Implementing a medication safety program designed by pharmacists
c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
d. Offering quarterly joint nurse-physician workshops to discuss unit issues
e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique
for handoff communication
ANS: A, D, E
Meaningful recognition, true collaboration, and skilled communication are elements of a
healthy work environment. Implementing a medication safety program enhances patient
safety, and if done without nursing input, could have negative outcomes. Staffing should be
adjusted to meet patient needs and nurse competencies, not have predetermined ratios that are
unrealistic and possibly not needed.

Another Random Scribd Document
with Unrelated Content

In one of those small white houses of Nazareth lived a young
Jewish girl named Mary. We do not know how she looked, for
although many artists have made pictures of her, all have drawn or
painted her as they imagined her to be, not as she was. All that we
really know of Mary, we read in two of the four gospels, Matthew
and Luke; and neither of these tell us anything about her early life or
her family. It has been said that her father's name was Joachim and
her mother's was Anna; but this is not found in either of the gospels,
and we do not know whether it is true.
We do know, however, that she was a pure-hearted, lovely girl,
who served the God of Israel with all her heart and lived a holy life.
She knew her Bible well, we are sure, for its words came readily to
her lips; and she was a girl who thought much and talked but little.
In those years she might have been seen often going with the other
girls of the village to the fountain for water, or sitting in the women's
gallery in the church, listening thoughtfully to the reading from the
Bible, and with her rich young voice joining in the chanting of
David's psalms.
In that land girls are promised in marriage while very young, and
Mary was at this time promised to be married to a man named
Joseph, who was a carpenter, or, as he is called in the gospels, a
worker in wood. The two families, Joseph's and Mary's, were not
rich. They belonged to the working class of people, but they were
not like many, wretchedly poor. They were just plain, honest,
working people, able to earn a comfortable living.

The well of the Virgin Mary, at Nazareth

Mary beheld the angel Gabriel suddenly
beaming upon her.
Although Joseph and Mary were of the common people, they
came from the noblest blood in all the land. Both were sprung from
the royal line of David, the greatest of the kings of Israel, and the
singer of many beautiful psalms. They lived in little one-room
houses, and their hands were hard from work, but they could trace
their line back to the palace where David the founder of their family
dwelt.

On one day Mary was alone. It may have been in her own little
home, or upon its roof, where she often went for prayer, or perhaps
under a tree on the hillside near the village. Just as Zacharias a few
months before had seen a heavenly, gloriously-shining being in the
Temple, so now Mary beheld the same angel Gabriel suddenly
beaming upon her. In a sweet voice he said:
"Peace be with you, Mary! You are in high favor and love, for the
Lord is with you!"
The voice was gentle, but the sight of this shining form filled the
young girl with alarm. She knew not what to think, nor why this
glorious being had come to her. But after a moment the angel went
on speaking, and said:
"Do not be afraid, Mary, for God has chosen you among all
women for his special favor. You shall have a son; and you shall give
him the name Jesus, because he shall save his people from their
sins. He shall be great, and shall be called the Son of the Highest
God. God shall give to him the throne and the kingdom of his father
David. He shall reign forever over the people of Israel, and of his
kingdom there shall be no end."
The angel paused and Mary found words to speak, tremblingly
and with fear:
"How can all this come to me? I do not understand what it all
means!"
Then the angel spoke again to the troubled and frightened girl:
"The Holy Spirit of God shall come to you, and the power of God
shall be upon you; and therefore that holy child that is to be given
you shall be called 'The Son of God.' Also, let me tell you that your
cousin Elizabeth is soon to have a son in her old age. This may seem
strange to you; but no word of God is without power. Every promise
of God shall surely come to pass."
Then Mary said:

"I am the Lord's servant, and I can trust him. Let it be to me as
you have spoken. I will rest without fear in the will of the Lord."
Then, as suddenly as he had come, the angel vanished out of
sight, and Mary was left alone. She was filled with wonder at what
she had seen and heard. Any young Jewish girl to whom came the
news that the words of the prophets in the Bible were now to come
true, that the long-promised King of Israel was soon to be born, and
that she should be his mother, would be amazed and perhaps
alarmed at the message.
Some girls would have talked about it, and might even be proud
at such an expectation. But Mary's was a quiet nature, not apt to
speak of her deepest thoughts. She felt in some way that there was
no one in her home or in her village with whom she could speak of
these things. She hid them silently in her heart, but thought about
them day and night.

Elizabeth greeting Mary: "Blessed, most blessed
are you among women!"

A
A Young Girl's Journey
CHAPTER 5
FTER THE visit of the angel and the message which he had
brought, Mary's mind was filled with many thoughts and her
heart was full. She was only a young girl, not older than sixteen
years, perhaps as young as fifteen; for if she were older she should
have been already married. In that land nearly all young women are
married as soon as they are sixteen years old; and very few stay
unmarried.
Mary felt that she must talk with somebody of all these wonderful
things that had been spoken to her. We would think that her mother
was the one with whom she could open her heart most freely, but
we are not sure that her mother was living. And is it not true that a
young girl can sometimes tell to a dear grandmother, or some other
old lady who is her friend, the deep things of the heart that she may
hesitate to mention even to her own mother?
She thought of one who was not her grandmother, but who from
her age and sweetness seemed like one. Her mind turned to
Elizabeth, living far away in the south. The angel, you know, had
told her that Elizabeth was also to have a child, and perhaps she
would be able to understand Mary's feelings better than any other
woman.
Elizabeth was related to Mary. She is named in the gospel of St.
Luke as Mary's cousin, though very likely they were not near, but
distant relatives. Mary knew that she was wise and good, that she
loved her, and being old, could give her advice. Mary made up her
mind to visit Elizabeth and open her heart with her fully about what

the angel had spoken to her. From Nazareth to Elizabeth's house was
a long distance, in a straight line more than eighty miles, but much
farther by the road which travelers from Galilee generally followed in
going from the north to the south of the land.
Very soon after the angel's visit, Mary left her home and began
her journey southward. Of course, a young girl could not take a
journey so long alone. But there were always caravans or parties
going from Galilee to Jerusalem, and Mary would travel with one of
those companies. A soldier would ride on a horse, a general in his
chariot, and an Arab on his camel; but most men in those times
walked, even on long journeys. A woman would ride on an ass,
which was the animal preferred by the Jews for travel.
We may think of Mary with a beating heart leaving her home in
Nazareth in company with a caravan or party of people journeying to
Jerusalem to attend one of the great feasts held every year in that
city. Their most direct way would be over the mountains; but it
would be rough and stony; up one mountain, down another, and
around a third mountain, nearly all the way. Besides, this way would
lead them through the country of the Samaritans, which lay between
Galilee and Judea, and such was the hatred between Jews and
Samaritans that it was scarcely safe for a company of Jews to go
through their land. A large company would need to stop by night at
some inn, and the Samaritans often shut their inns against those
who were going to Jerusalem.
The line of travel from Nazareth would be to go over the steep hill
on the south of their village, then follow a well-trodden way
eastward down to the river Jordan. There they would find a very
good road built by the Romans, straight down the Jordan Valley, with
mountains on either side. This they would follow about sixty miles
until they came to Jericho. There they might rest for a few days; and
then climb the steep path up the mountains to Jerusalem. This
Jericho road was a hiding place for robbers, and it was never safe
for anyone to travel it alone. But in a large company, with many
men, and often a guard of soldiers, the travelers need not fear. They

would easily reach Jerusalem in a week or ten days after leaving
Nazareth, and might make the journey in five days if they were in
haste.
In Jerusalem Mary would visit with some friend. All the families in
the land had friends in Jerusalem with whom they stayed while
attending the great feasts, of which three were held each year; and
the dwellers in Jerusalem opened their houses to the same families
year after year. After the feast, Mary would find another caravan or
party going home to Hebron and the villages near it, and she would
travel the rest of her journey, about twenty miles, with this party.
Altogether, Mary's journey, from Nazareth to Hebron, was nearly one
hundred and twenty miles long. Although many people were with
her all the way, she was alone in spirit, for she could speak to no
one of the great thoughts which burdened her mind and her heart.
At last her long journey was over. She stopped at the door of the
house of Zacharias; and in a moment was clasped in the arms of
Elizabeth. In some strange way God had given to Elizabeth to know
all that had come to Mary. In a loud voice she said:
"Blessed, most blessed are you among women! And blessed
among men shall be the son born to you! High indeed is the honor
mine today when the mother of my Lord comes to my home!
Blessed is she that believed the angel's word, for that word shall
surely come true!"
In that moment Mary's feelings, long held in, broke out into song.
For this young woman's soul was not only pure and tender and
devout, it was the soul of a poet whose thoughts shape themselves
into verse. Mary spoke and sung a song which has become famous.
Someone wrote it down, and Saint Luke, who wrote the gospel,
found a copy of it and gave it to the world. Everyone should read it.
We give it here.
MARY'S SONG

My soul beholds the greatness of the Lord,
And my spirit hath rejoiced in God my Saviour.
For he hath looked upon his servant in my lowly
state;
And from this time people in all ages shall call
me blessed.
For he that is mighty hath done to me great
things;
And holy is his name.
And his mercy is from age to age
On those who fear him.
He hath showed strength with his arm;
He hath scattered the proud in the vain
thoughts of their heart.
He hath put down princes from their thrones,
And hath lifted up those of humble state.
The hungry he hath filled with good things;
And the rich he hath sent empty away.
He hath given help to Israel his servant
That he might remember mercy
As he spoke to our fathers,
Toward Abraham and his children forever.
For three months Mary stayed with Elizabeth in that quiet home,
the old woman and the young woman, both soon to be mothers,
talked together day after day. Perhaps by this time people were
going to another feast in Jerusalem, and Mary found again a party of
pilgrims—for that was the name that they gave to people going to
Jerusalem to worship—who were returning to Galilee. She went
home, comforted in spirit and made strong by her visit with
Elizabeth.

It was either while Mary was visiting with Elizabeth, or soon after
her return to her home, that Joseph, her promised husband, began
to question in his mind whether he ought to marry her. There was a
strange look in her face, and he saw that she had thoughts in her
mind of which she could not speak to him. He loved her deeply, and
it was with sorrow that he asked himself whether they would be
happy together.
But one night, while he was sleeping, a dream came to Joseph. In
his dream he saw an angel standing by his side. The angel said to
him:
"Joseph, son of David, do not be afraid to take Mary for your wife.
She shall have a son; and his name shall be Jesus, for it is he that
shall save his people from their sins."
The word Jesus, in the language of that people, means "Saviour,"
and often Jesus is spoken of as "Our Saviour" because he came to
take away our sins.
After this message, Joseph hesitated no longer. He did as the
angel had bidden him. He was married to Mary, and led her to his
own home, in which was also the shop where he followed his trade
as a carpenter.

N
The Boy Who Never Tasted Wine
CHAPTER 6
OT LONG after Mary's visit, the child promised to Zacharias
and Elizabeth was born. In Jewish families the coming of a
child into the home was always the cause of great gladness; and the
gladness was greater at the birth of this baby, because this was the
first child, and the father and mother were old. All the friends of
Zacharias and Elizabeth came to see them and to rejoice with them
over the boy whom God had given them.
"He must be named Zacharias after his father," said the visitors.
"Not so," answered the mother; "he shall be named John."
"Why should you give him that name?" they said. "None of your
family has ever been called John."
But Elizabeth insisted that her boy should bear the name John.
You remember that Zacharias had been stricken dumb at the time
when the angel spoke to him in the Temple. In all the months since
he had not spoken a word. Nor could he hear what was said; for
now they made signs, to ask him what should be the child's name.
They brought him a writing table, and on it he wrote, "His name is
John." So that was the name of this child of promise, just as the
angel Gabriel had said.
You may ask, what was a writing table? In those times paper was
very scarce and high in its cost. It was used only for writing down
matters that were important. For common uses, each family had a
writing table, which was a board over which was spread a thin layer

Writing tablets
of wax. On this wax they marked what they wished to write, with a
sharp-pointed pen of iron or steel. This kind of a pen was called a
stylus. The other end of the pen was flat, like an ivory paper-cutter.
After writing, they could smooth it all out again; and the wax was
then ready to be used once more.
Just as soon as Zacharias had written the words "His name is
John," the power to hear and to speak came back to him. He began
to praise God in a loud voice, and gave forth a song of rejoicing.
This song was afterward written, and may be read in the gospel by
St. Luke, near the end of the first chapter.
In this song,
Zacharias gave thanks
to God for having
blessed his people and
kept the promises that
had been made in God's
name by all the
prophets of old time.
The prophets, as you
may know, were the
good men who listened
to God's words and then
gave them to the
people, speaking with
God's power; and
sometimes telling, long
before the time, of great events that were to take place. They were
men like Moses, who saw God face to face, and Samuel the wise
ruler, and Elijah the prophet of fire, and Isaiah, who declared Christ's
coming long before his day. In the Old Testament times there was
always a prophet to tell the people the will of God. But since the Old
Testament had been finished, almost five hundred years before this
time, no prophet had stood up in Israel with the word of the Lord.

Zacharias knew that this newly-born child should grow up to give
God's message to the people. He said in his song:
"And you, O child, shall be called the prophet of
God;
For you shall go before the Lord Christ, to
make ready a way for him;
You shall give to his people the good news of a
Saviour,
And the forgiveness of their sins
Because of the tender mercy of God."
John the Baptist in the desert
In the home of Zacharias and Elizabeth the baby John grew up a
strong, noble boy. Very early they told him of the angel's visit, and of
the command that throughout his life he was not to taste wine nor
any strong drink. He was under a vow or pledge of special service
for God; and one sign of his pledge was to be his not tasting wine
nor even eating grapes. Another sign was in leaving his hair to grow
long and never cutting it. Everyone who saw him would know by
these signs that he was pledged to a life of peculiar service to God.
When John became a young man he went away from his home
and lived in the desert, alone with his own thoughts and with God.

Very likely, his father and mother died before he went to live alone,
for at the time of his birth they were old people and could not live
many years.
John lived upon the plainest of food, the locusts that could be
gathered in the field, and were boiled, to be eaten by the poorest
people. He ate also the honey made by the wild bees and stored by
them in hollow trees and holes in the rocks. All those years of his
young manhood, John was thinking upon the work to which God had
called him, talking with God and learning God's will; so that when
the time came, he could give God's message to the people.
Plowing in Bible time

They sought out the inn at Bethlehem but
Joseph found within its walls no place where his
wife could rest after her long and wearisome
ride.

F
The Child-King in His Cradle
CHAPTER 7
OR A FEW months after their marriage, Joseph and Mary lived
in their little house at Nazareth. Joseph worked at his trade as a
carpenter, while Mary cared for the home and carried the water for
the needs of the house from the well in the middle of the village,
walking with her jar full of water on her head.
One day Joseph came home and told his wife that he had been
called to go on a journey to Bethlehem, which was the town from
which their family had come. Both Joseph and Mary, as we have
seen, had sprung from the line of the great King David, who had
been born in Bethlehem more than a thousand years before. Every
one who belonged to the line of David, wherever he might be living,
looked upon Bethlehem as the home-town of his family.
The Emperor Augustus at Rome, who ruled over all the lands and
was above Herod, the king of Judea, had given orders that a list
should be made of all the families in his wide empire. He wished to
lay a tax upon every family; that is, to call upon every family to pay
money for the support of his officers, his army, his court; and in
order to fix this tax, he must have written down the names of all the
people.
In our land such a list is made every ten years, and is called a
census. With us, men are chosen in every city and town to go to the
people where they live and make the list of their names. From all the
states throughout the land, these lists are sent to one office, and
there the names are arranged in order.

Church of the Nativity, Bethlehem, said to enclose the
birthplace of the Saviour

The shepherds came to the stable, opened the
door and found just what the angel said they
would see, a tiny babe lying in the manger.
But the Romans who were ruling the world at that time chose a
plan for making this great list which would give themselves the least
trouble, even though it gave to the people under them much more
trouble, and compelled them to make long journeys. Instead of
appointing in each place an officer to take the names of the people
at the places where they were living, they made a law that every
family must go to the city or town from which they or their fathers

had come, and there give their names to the officers who were
making the roll of the people. Those who were living in Jerusalem,
and had come from Shechem or Joppa or Cæsarea, must journey to
one of these places and there make their report; those who were
living in Nazareth and had come, or their parents before them had
come, from any other place, must go to their home-town, however
far it might be, and in that place be enrolled or written upon the list
of names.
There is no reason to suppose that Mary, although herself sprung
from the family of David, was compelled to make this journey to
Bethlehem with her husband. The Roman laws took very little notice
of women, unless they were rich women who could be taxed. Joseph
could go alone to Bethlehem, and there have both their names
written upon the list. But at once a thought came to Mary, and she
said to her husband:
"You shall not make the journey to Bethlehem alone. I will go
with you."
We are not told why the young wife was resolved to go with her
husband on the long journey, but the reason may have been this:
Mary knew that she was to have a son, and the time for his coming
was now near at hand. She knew, too, that her child should be the
Son of David and the King of Israel, that he was to sit on David's
throne. She wished him to be born, not in the village of Nazareth in
Galilee, but in David's own town of Bethlehem. He was to spring
from the royal line, and she was willing to endure a hard, trying
journey, and even to suffer, that her son might come from the royal
city where David lived. Mary had read the books of the Old
Testament, and she knew that in those books it had been written by
the prophets, to whom God had spoken, that this king, whom they
called Messiah and Christ, should be born in Bethlehem. These were
the reasons that made Mary decide so quickly to go with her
husband on his journey to Bethlehem, the city of their fathers.

So Joseph locked up his carpenter's shop and set his wife upon an
ass, and with a staff walked beside her, over the mountain and down
the valley to the river Jordan, and thence following the river, over
the Roman road, the same long road that Mary had taken in the
caravan or company of pilgrims some months before. Joseph had
been over that road many times, going up every year to the feasts
at Jerusalem, so that he knew all the places which they passed, and
could tell Mary stories of their people and the great events which
had taken place on the mountains or in the cities as they came into
view in their journey.
They stopped at Jericho, near the head of the Dead Sea, and
there turned westward, climbing the mountains over the robber-
haunted road, and reaching Jerusalem. Perhaps they rested a day or
two in this city and then went over to the mount of Olives, past the
village of Bethany; and six miles south of Jerusalem they entered
the gate of Bethlehem.
They had no friends with whom they could stay in Bethlehem,
and so they sought out the inn, or the khan, as it was called. This
was a large building with rooms around an open court. In this court
the animals and the baggage were placed, and the guests of the inn
were in the rooms around it. But Joseph and Mary were not the only
people who had come to Bethlehem to have their names enrolled or
written upon the lists for the taxing. Others had reached the inn or
khan before them. When they came the courtyard was filled with
asses and camels and chariots and baggage, and all the rooms
around the court were crowded with visitors. Joseph found within
the walls of the khan no place where his wife could rest after her
long and wearisome ride.
But at last Joseph learned of a place where they might stay
through the night and for a few days. It was only a cave, hollowed
out in the hillside, used as a stable for cattle; but miserable as it
was, Mary was glad to lie down upon the straw and rest. And in that
cave-stable Mary's child was born. She wrapped her little baby in
such clothes as she could find at hand, and laid him for his first

sleep in the manger where the oxen had fed. This was the lowly
cradle of the Son of David, the King who was to rule over all the
earth! King Herod in his palace did not know, and the Emperor
Augustus at Rome did not dream, that in the humble stable at
Bethlehem was lying a Prince who should reign over a realm vastly
greater than Judea or the Roman Empire; that all the world should
date their years from the year when that baby was born; and that
his name would be praised long after their names had been
forgotten.
Main street in Bethlehem
But although neither King Herod, nor the Emperor Augustus, nor
the high-priest and rulers in Jerusalem were there to welcome their
new-born King, there were some visitors at his manger-cradle. In the

open fields around Bethlehem were shepherds, watching at night
over their flocks of sheep, just as, a thousand years before in the
same fields, the young shepherd David had cared for his sheep,
guarding them from wild beasts of the wilderness and from robbers.
Suddenly a great, dazzling light flashed upon these shepherds,
and they saw, as Zacharias had seen by the altar, and as Mary had
seen in Nazareth, a glorious angel standing before them. The
shepherds were filled with fear and fell upon their faces on the
ground, not daring to look up at the shining form. But the angel
spoke to them kindly and graciously, saying:
"Do not be afraid, for I come with good news, which will make
you glad; news for all God's people. On this very night is born in
yonder city of David, one who shall be the Saviour, even Christ your
Lord and King. Would you wish to go and see this child? I will tell
you how you can find him. Look for a newly-born baby wrapped in
such clothes as babies wear, and lying, not in a cradle in a house,
but in the manger of a stable, where the oxen and the asses are
kept. There you will find the child who is to be the King of all the
earth!"
While shepherds were listening to the words of this angel, they
saw that the entire midnight sky over them was filled with a
multitude of heavenly beings. The shepherds heard them sing:
"Glory to God in the highest,
And on earth peace among men in whom God
is well pleased."
Then the vision faded away, the angelic host passed out of sight,
and in the dark sky only the stars were shining above them. Then
the shepherds said to each other:
"Let us leave our sheep here for a little while, and go to the
village and see this wonderful thing that has come to pass. How
good it is that the Lord has given this word to us, that we may be
the first to look upon our King!"

It did not take the shepherds a long time to find the right stable
and the manger, for Bethlehem was then only a small village. They
came, opened the door, and found just what the angel had said they
would see, a tiny baby lying in the manger, his mother hovering
near, and Joseph watching over them both in tenderness.
They saw the royal little one, and bowed low around his manger
cradle, then went again to their flocks in the field, praising God for
his goodness in sending the long-promised King. The people to
whom the shepherds told this story, wondered at it, hardly knowing
whether to believe it or not; for this was not the way in which they
looked for the King of Israel to come. They were expecting a prince
to be born in a palace, not a working-woman's child in a dark cave
where cattle were kept.
But Mary, happy with her little one, clasped him to her heart and
said nothing to anyone of the angel that had come to her in
Nazareth, and of the promises given her about this child. When the
day came to name the child, she simply said, "His name shall be
Jesus," but she told no one why the name was given. It was a
common name among the Jews, so no one was surprised at the
name. But no word could tell better than his name "Jesus" what this
child should become, for the word Jesus means "Saviour."

Simeon came forward and took the infant Jesus
into his arms, and lifting up his eyes to heaven
gave thanks that he had seen the Saviour.

A
The Baby Brought to the Temple
CHAPTER 8
LTHOUGH JESUS was born in a stable and slept in a manger,
he did not stay in that place long. After a few days Joseph was
able to find a more comfortable home, where the young mother and
her baby were taken. The Jews were very kind to strangers of their
own people, and welcomed them to their houses when passing
through their towns.
Joseph and his family were in Bethlehem for some weeks,
perhaps for some months. It may have been their purpose to make
Bethlehem their home, and to bring up this child, the Son of David,
in David's own city, where he could have a better training for his
coming life, whatever that life might be, than in the country village
of Nazareth.
On the day when Jesus was forty days old, he was brought with
his mother to Jerusalem, which was only six miles from Bethlehem.
There he was taken to the Temple for a service which showed that
he was given to God and to be brought up as God's child. It was the
rule of the Jews that after the first child had come to a family, an
offering should be made on the altar in the Temple for him and
prayers should be said. A family that was rich would offer for their
first child a sheep, which was killed and burned on the altar as a gift
to God in place of the child. If the family was poor, or of the working
class of people, the parents offered a pair of doves or pigeons.
Joseph and Mary brought a pair of doves, and stood by while these
were burned on the altar, Mary holding her baby in her arms.

At that moment there was in the Temple an old man named
Simeon. He was a good man and very earnest in his prayers to God
that he might live to see the Messiah-King of Israel, the Christ of
God, who had been promised through the prophets of old. And God
had said to Simeon that he should not die until he had seen Christ.
On that morning a voice had seemed to say to him, "Go to the
Temple." He obeyed it, not knowing why he had been sent to that
place on that day.
As Joseph and Mary brought the baby Jesus into the Temple, the
voice of the Lord spoke again to Simeon, saying:
"This child is David's Son, the King of Israel."
Mary and the doves

The old man came forward, held out his arms, and took the child
into them, folded him to his bosom, and lifting up his eyes to
heaven, said in Hebrew verse:
"Now, Lord, thou mayest let thy servant go
According to thy word, in peace.
For these eyes of mine have seen thy Saviour
Whom thou hast sent to all the people.
A light to shine upon the nations,
And the glory of thine own people Israel."
Joseph and Mary were filled with wonder at the act and words of
the old man, whom they had never seen before and did not know.
But as he placed the child in their arms again, he prayed for God's
blessing upon both Joseph and Mary.
"Listen," he said, "this child will become a cause for many to fall
and to rise again in Israel. He shall be God's sign of mercy, but many
shall speak against him. Also, sorrow like a sword shall pierce
through your soul, O mother; and the thoughts out of many hearts
shall be made known."
Those words seemed very strange at the time; but long
afterward, when Jesus had grown to be a man, Mary found how true
they were, as she saw enemies gathered against her son, and at last
looked at him dying upon the cross. Then, indeed, a sword went
through Mary's soul.
Just at that moment a woman came up to the little group. She
was very old, more than ninety years of age; and being a widow and
a devout worshipper of God she stayed nearly all her days in the
Temple praying. God had spoken to her also with the promise of a
coming Christ, the Saviour and King. She too saw in this little baby
the promised Messiah, and in a loud voice gave thanks and praise to
God. All who heard her wondered at her words, and wondered all
the more as they looked on this plainly-clad father and mother with

their baby, all evidently from the country, and the speech of Joseph
and Mary showing they had come from Galilee in the far north.
Thus even while Jesus was a very young baby, only forty days
old, here in Jerusalem a few people had looked upon him and
spoken of him as the coming King of Israel.
Joseph and Mary carried the child back to their new home in
Bethlehem; and Mary had more thoughts to hide within her silent
heart long after that day in the Temple.

W
The Followers of the Star
CHAPTER 9
HILE JOSEPH and Mary with the child Jesus were still staying
in Bethlehem, the city of Jerusalem was stirred by the
coming of some men from a land far away, with a strange question.
These men were not Jews, but were Gentiles, which was the name
that the Jews gave to all people except themselves. All Romans and
Greeks and Egyptians and all others who were not of their own race,
the Jews called by the name "Gentiles." These Gentile strangers who
came to Jerusalem were asking of everybody whom they met this
question:
"Can you tell us where is to be found the little child who is born to
be the King of the Jews? We have seen his star in the east, and we
have come to do him honor?"
Who were these men, and what was the star that they had seen?
We are not certain as to their land, but it is generally thought to
have been the country now called Persia, then known as Parthia, a
land about a thousand miles to the east of Judea. Although some
Jews lived in that land—for Jews were to be found then as now in all
lands, especially in large cities—the people of Parthia were not Jews,
but, as the Jews called them, Gentiles. Although not of the Jewish
race, these people were like the Jews in one respect—they never
bowed down to worship images which men had made. They
worshipped the One God of all the earth; and they prayed with their
faces toward the sun. They said that they did not worship the sun,
but the One God who was like the sun, the light of the world.

Among these Parthian people were many men who at night
studied the stars in the sky. They did not have telescopes, as those
who look at the stars now have, to bring the heavenly bodies, the
moon, the planets, and the stars nearer to them; they could only
use their own eyes, but by long study they had learned much about
the stars, could tell of their movements and where in the sky to find
each one of them. The men who gave their lives to this study of the
stars were called Magi, a word meaning "Wise Men"; and these
strangers who were seeking the child-king in Jerusalem are
sometimes spoken of as "the Wise Men," sometimes as "the Magi."
The Wise Men on their journey
The people of that time believed that when great kings were
born, or before they died, strange stars suddenly appeared in the
heavens, shone for a time and then as suddenly passed out of sight.
A year or perhaps two years before Jesus was born in Bethlehem,
such a star, very bright, that had never before been seen, began to
shine. In some way it came to the minds of these men that this star
pointed to the coming of a great king who was to rule over all the
lands, and who was to be found in the land of Judea.

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