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Contributors
Marlene Brennan, DNP, FNP-BC, PMHNP-BC Sandra Ripper-Brown, DNP

Assistant Professor Neuroscience Program
Christine E. Lynn College of Nursing St. Mary’s Medical Center
Boca Raton, Florida West Palm Beach, Florida
Sharon K. Byrne, DrNP, CRNP, NP-C, AOCNP, Denese Sabatino, MSN, ARNP-C, CCRN
CNE Nurse Practitioner/Clinical Educator, Department
Co-Chair, Department of Nursing of Critical Care
Assistant Professor, School of Nursing, Health and Cleveland Clinic
Exercise Science Weston, Florida
The College of New Jersey Baptist Hospital
Ewing, New Jersey Miami, Florida
Denise Vanacore, PhD, CRNP, ANP-BC,

Karin Klause, MSN, FNP-C PMHNP-BC
Florida Community Health Centers, Inc. Director, NP and DNP Programs
Fort Pierce, Florida Gwynedd Mercy University
Gwynedd Valley, Pennsylvania
Gary Laustsen, PhD, FNP-BC, FAANP, FAAN
Assistant Dean, Academic Practice and Innovation Kenneth Winland, MS
Assistant Dean, Practice and Community Engagement Warren, Rhode Island
Associate Professor/FNP
Oregon Health & Science University Karen Wisdom-Chambers, DNP, FNP-BC
School of Nursing Portland Campus Instructor, NP Program
Portland, Oregon Christine E. Lynn College of Nursing
Florida Atlantic University
Donna Maheady, EdD, APRN-BC Boca Raton, Florida
President, www.exceptionalnurse.com
Adjunct Faculty We would also like to thank the following individuals
Utica College for contributions to previous editions:
St. Petersburg, Florida Sandra Allen
Lisa J. Bedard
Denise Coppa
Kymberlee A. Montgomery, DrNP, WHNP-BC, Marcia Gardner
CNE Diane Gerzevitz
Drexel University Allison M. Jedson
College of Nursing and Health Professions Janice S. Hayes
Philadelphia, Pennsylvania Deborah A. Raines
Karen Rugg
Lynne Palma, DNP, FNP-BC, CDE Lorraine M. Schwartz
Associate Professor Susan Elaine Sloan
Christine E. Lynn College of Nursing Douglas H. Sutton
Florida Atlantic University Sharon A. Thrush
Boca Raton, Florida Marcella R. Thompson
vii
4469_Winland-Brown_FM_i-x.indd vii 3/21/17 3:04 PM

Acknowledgments
We would both like to thank the entire F. A. Davis team, especially Susan
R. Rhyner, Senior Acquisitions Editor, for her vision, enthusiasm, and sup-
port; Marcia L. Kelley, Developmental Editor, for her expertise, efficiency,
and good humor; and Amanda Minutola, Echo Gerhart, Dan Clipner, and
Christine Becker, Editorial and Production Managers, for hanging in there
with us every step of the way!!! Day by Day!
JW-B & LMD
viii
4469_Winland-Brown_FM_i-x.indd viii 3/21/17 3:04 PM

Contents
UNIT ONE 1
Introduction 1
1. Achieving Success on a Certification Examination 3
LYNNE M. DUNPHY and GARY LAUSTSEN
2. Test-Taking Skills and Designing Your Study Plan for APRN Certification 9
LYNNE M. DUNPHY and GARY LAUSTSEN
UNIT TWO 25
Evaluation and Promotion of Client Wellness 25
3. Health Promotion 27
JILL E. WINLAND-BROWN
4. Care of the Emerging Family 55
DONNA C. MAHEADY and JILL E. WINLAND-BROWN
5. Growth and Development 85
LYNNE M. DUNPHY
6. Health Counseling 117
LYNNE M. DUNPHY
UNIT THREE 155

Assessment and Management of Client Illnesses 155
7. Neurological Problems 157
JILL E. WINLAND-BROWN and SANDRA RIPPER-BROWN
8. Integumentary Problems 183
JILL E. WINLAND-BROWN and KARIN T. KLAUSE
9. Head and Neck Problems 209
KAREN W. CHAMBERS and LYNNE M. DUNPHY
10. Respiratory Problems 239
JILL E. WINLAND-BROWN and KARIN T. KLAUSE
11. Cardiovascular Problems 265
DENESE SABATINO and JILL E. WINLAND-BROWN
12. Abdominal Problems 299
JILL E. WINLAND-BROWN and KENNETH WINLAND
13. Renal Problems 325
JILL E. WINLAND-BROWN and KENNETH WINLAND
14. Male Genitourinary Problems 351
SHARON K. BYRNE and LYNNE M. DUNPHY
15. Female Genitourinary Problems 377
KYMBERLEE A. MONTGOMERY and JILL E. WINLAND-BROWN
ix
4469_Winland-Brown_FM_i-x.indd ix 3/21/17 3:04 PM

x CONTENTS
16. Musculoskeletal Problems 407

SHARON K. BYRNE and LYNNE M. DUNPHY
17. Endocrine and Metabolic Problems 437
LYNNE PALMA and JILL E. WINLAND-BROWN
18. Hematological and Immune Problems 467
LYNNE M. DUNPHY and JILL E. WINLAND-BROWN
UNIT FOUR 495

Issues in Primary Care 495
19. Issues in Primary Care 497
LYNNE M. DUNPHY and MARLENE BRENNAN
UNIT FIVE 527

Practice Examination 527
Comprehensive Practice Examination 529
JILL E. WINLAND-BROWN and LYNNE M. DUNPHY
4469_Winland-Brown_FM_i-x.indd x 3/21/17 3:04 PM

UNIT ONE
INTRODUCTION
4469_Winland-Brown_Ch01_001-008.indd 1 3/18/17 12:58 PM

Chapter 1: Achieving Success
on a Certification Examination
Certification and Why It Is Important
Licensure
Certification
Your Role
Certification Examinations
American Nurses Credentialing Center
American Academy of Nurse Practitioners Certification
Program
Achieving Success
References
Lynne M. Dunphy
and Gary Laustsen
With the purchase of this book, you have taken a programs, and most states require individuals to main-
major step to achieving or maintaining your certain their RN license to apply for and maintain their
tification as an advanced practice registered nurse APRN license. All but a few states currently require
(APRN). The earlier in your educational process you certification to apply for an APRN license. In addition
begin preparing for the certification examination, the to the states’ requirements of certification for licen-
greater your chance of success. This book will help sure, clinical facilities, employers, and insurance pay-
you understand the certification process and the steps ers require certification.
you need to take to succeed on the certification exam-
ination of your choice.
CERTIFICATION
Certification is the process by which a nongovern-
Certification and Why It Is Important mental agency or association grants recognition to
an individual who has met certain predetermined
There are basic differences between becoming licensed standards for practice. For APRN certification, this
(a process you complete with your state’s board of is achieved through the successful passing of a cer-
nursing or similar entity) and becoming certified. An tification examination. Becoming certified is the
understanding of these differences is important. standard for APRN professionals. As of this writing,
only New York, California, Indiana, and Kansas do
not require certification prior to obtaining licensure
LICENSURE
to practice as a family nurse practitioner (FNP) or
Licensure is a legal requirement of each state to prac- adult-gerontology primary care nurse practitioner
tice nursing in that state. The purpose of licensure is (AGPCNP).
to protect the public from unsafe practitioners. Legal Certification exams, based on an analysis of cur-
regulation of nursing practice (whether at the RN or rent practice, validate entry-level knowledge in an
APRN level) is the joint responsibility of the state leg- advanced nursing specialty in a defined population
islature and the state board of nursing (and in some area. Certification exams are competency-based ex-
states the board of medicine). Registered nurse (RN) aminations that provide a valid and reliable assess-
licensure is a requirement for enrolling in APRN ment of entry-level clinical knowledge and skills of a

4 unit one: INTRODUCTION
APRN REGULATORY MODEL
APRN Specialties
Focus of practice beyond role and population focus linked to health-care needs
Examples include but are not limited to Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care
Population Foci
Licensure occurs at levels
of role & population foci
Family/Individual Women’s Health/ Psychiatric-

Adult-Gerontology Neonatal Pediatrics
Across Life Span Gender-Related Mental Health
APRN roles
Nurse Clinical Nurse Nurse

Anesthetist Nurse-Midwife Practitioner
Specialist
Figure 1-1
nurse practitioner. This certification aligns with the

Box 1-1: Purposes of National Certification
Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification, and Education (LACE). • Required for advanced nursing practice licensure in
Certification exams are administered through testing all but a few states
divisions of professional associations. These include • Indicates specific advanced role and population-
the American Nurses Association (ANA) subsidiary, the based competencies at an entry level building on
foundational nursing knowledge
American Nurses Credentialing Center (ANCC),
• Required for third-party reimbursement in Medicare
and the American Association of Nurse Practitioner’s populations as well as by most other insurers
American Academy of Nurse Practitioners Certifi- • Often required for institutional credentialing
cation Program (AANPCP). National certification • Required by the U.S. Department of Veterans
examinations by these bodies designate an APRN Affairs and the U.S. Armed Forces
role in a specific population (see Fig. 1-1), serve as • Required to obtain a National Provider Identifier
(NPI)
eligibility for licensure to practice in most states, and
are required for most third-party reimbursement, as
well as institutional credentialing. For a list of some
of the main purposes of national certification, review Box 1-2: Recognized Nursing Associations
Box 1-1. and Organizations Offering Advanced-Practice
In summary, the candidate for certification as an Nursing Certification for the Nurse Practitioner
APRN should recognize that certification is a formal Role
process conducted by nongovernmental organizations
to validate entry-level APRN knowledge, skills, and American Academy of Nurse Practitioners Certification
Program (AANPCP): http://www.aanpcert.org
competencies, based on predetermined standards and
practice analysis, and is a part of the requirement in American Nurses Credentialing Center (ANCC):
most states to obtain licensure and status as an APRN. http://www.nursecredentialing.org
See Box 1-2 for recognized certifying organizations for
FNP or AGPCNP practice.
retesting. The purpose of this book is to help you
achieve that goal, but your role in this process requires
YOUR ROLE
a commitment in time and effort to be successful.
You are making an important decision to become Table 1-1 lists the requirements for nurse prac-
an APRN or to maintain your certification through titioner certification by the ANCC and AANP as of

chapter 1: ACHIEVING SUCCESS ON A CERTIFICATION EXAMINATION 5
TABLE 1-1. REQUIREMENTS TO SIT FOR TABLE 1-2. ANCC FAMILY NURSE
NURSE PRACTITIONER CERTIFICATION PRACTITIONER CERTIFICATION
EXAMINATION CONTENT OUTLINE (2016)
ANCC AANP
DOMAINS OF NUMBER OF PERCENT OF
• Present final, • Be a graduate (or imminent PRACTICE QUESTIONS QUESTIONS
degree-conferred graduate) of an accredited
transcripts Master’s NP, post-graduate Foundations for 64 37
• Present validation NP, or DNP program Advanced Practice
of Education • Present official final Professional Practice 30 17
Form signed by transcript with date degree Independent Practice 81 46
program director/ conferred
Total 175 100
faculty • Complete program faculty–
supervised clinical clock
hours
• Hold a current RN license describes the major categories and domains of practice,
as well as related topics and subtopics, which are cov-
ered on the examination. The examination currently
consists of 200 questions, 175 of which are scored and
2015. You must keep abreast of both of these creden- 25 pilot questions that are not scored. The nonscored
tialing Web sites for continued and changing infor- questions cannot be distinguished from the scored
mation regarding the details and processes for taking items.
the certification exam. To qualify to take an examina- The TCO includes information about how the
tion and become certified at the APRN level, a nurse content is weighted—that is, how many or what
must (1) meet the requirements for clinical or func- percentage of the test questions are in each of the
tional practice in a specialized field and (2) provide major domains. Table 1-2 lists the major categories
evidence of successful completion of an approved or domains of practice for the FNP examination and
Master or Doctor of Nursing Practice curriculum. includes an approximate number of questions and
the overall percentage for each category. To facili-
tate understanding of each of the major domains, the
ANCC also includes subcategories in a topical outline
Certification Examinations
format. Table 1-3 provides similar information for the
AGPCNP examination.
This book is geared toward the person who is seeking
The importance of reviewing the current handbook
national certification as an AGPCNP and/or FNP.
and TCO before sitting for the examination cannot be
The AGPCNP certification examination is designed
to assess your abilities as an APRN in the delivery of
primary care services to an adult population, defined as TABLE 1-3. ANCC ADULT-
adolescence through old age. The gerontological nurse GERONTOLOGICAL PRIMARY CARE
practitioner (GNP) certification is no longer offered NURSE PRACTITIONER CERTIFICATION
by either ANCC or AANPCP. EXAMINATION CONTENT OUTLINE (2016)
The FNP certification examination is designed to
assess your abilities as an APRN in the delivery of pri-
mary care services across the life span, including pre- DOMAINS OF NUMBER OF PERCENT OF
and postpartum care, pediatric primary care, and the PRACTICE QUESTIONS QUESTIONS
care of older adults. This spectrum of care is sometimes
referred to as “cradle to grave.” Foundations of 51 29%
Advanced Practice
Nursing
AMERICAN NURSES CREDENTIALING Professional Roles 51 29%
CENTER Independent Practice 73 42%
The ANCC Web site contains the certification hand- Total 175 100%
book, including a test content outline (TCO) that

overstated. All questions are classified according to life an additional 30 minutes for check-in and practice
span and problem-focused content areas. The life span time at the computer, including a tutorial. Because it
dimension for the AGPCNP examination includes is a computerized examination, you will receive your
non–age-specific content as well as specific content score 3 to 5 minutes after completing the examina-
pertaining to the adolescent, the adult, and the aging tion. A passing score is 350 or higher of a possible 500
adult. The FNP life span dimension includes the same points; 2014 statistics reveal 80.5% of AGPCNP and
content as the AGPCNP examination plus content 73.8% of FNP candidates passed on their first attempt.
relating to children, infants, and childbearing women. If not successful, a candidate can apply to retest after
The gerontological population is defined as persons 90 days.
older than age 65. You will need to be recertified every 5 years. At
The last dimension is related to problem areas and present, 500 hours of active practice must be attested
organizes question content by body system—for exam- over the previous 5 years. Additionally, continuing
ple, cardiovascular, endocrine, and respiratory. education credits and/or academic credit must be doc-
What this means is that each test question in the umented. If not able to clinically practice, or if there
Foundations for Advanced Practice and the Indepen- is a lack of continuing education and/or academic
dent Practice domains is characterized across three credit, a practitioner may elect to retake the certifi-
dimensions. For example, a test question that asks cation examination as a way of demonstrating current
about the treatment of a 70-year-old woman with a competency. Please check the ANCC Web site for the
diagnosis of osteoporosis would be characterized as most current information because guidelines for recer-
follows: tification are subject to change.
• Dimension 1—Clinical Management

AMERICAN ACADEMY OF NURSE
• Dimension 2—Life Span: Older Adult PRACTITIONERS CERTIFICATION
• Dimension 3—Problem Area: Musculoskeletal PROGRAM
Be aware that the TCO may change from exam- The AANPCP currently offers competency-based
ination to examination, so you need to review your national certification examinations for the AGPCNP
handbook carefully for the most current content and FNP. Reflecting APRN knowledge and exper-
breakdown. tise, the content areas of these examinations include
To assess each examinee’s level of specialty knowl- health promotion, disease prevention, and diagnosis
edge independent of the group taking the examina- and management of acute and chronic diseases. The
tion, a criterion-referenced standard is used. In this examinations given by the AANPCP were developed
approach, each examinee’s score is compared with an in conjunction with the Professional Examination
absolute number determined by the content experts Service, a not-for-profit organization with more than
who develop the examination. You need to answer 50 years of experience in developing and administer-
every question. Even if you have no idea of the answer, ing national licensing and certification examinations
by sheer chance alone you stand a 25% chance of in health-related fields.
guessing the correct answer. You are not penalized for In order to take either certifying examination,
incorrect answers. candidates must possess a master’s or doctoral degree
The test-development committee determines (DNP) from an accredited program. This certification
the passing score after careful consideration of the program is fully accredited by the National Commis-
content of the test questions. The passing score is sion for Certifying Agencies (NCCA).
always expressed in terms of the number of questions The AANPCP, in conjunction with the Pro-
you must correctly answer on the total test. Diag- fessional Examination Service, conducted a role-
nostic feedback is given if the examinee fails the delineation study to determine areas of clinical
certification exam. Additional statistical examina- knowledge to be tested. As a result of this study,
tion of the pilot questions is assessed for inclusion the examination was structured around assessment
in the final graded pool of test questions on the next (approximately 48 questions, or 36%), diagnosis
examination. (approximately 33 questions, or 24%), formulation/
Your performance on the total test determines planning/implementation of treatment plans (approxi-
your success or failure. The examination is adminis- mately 31 questions, or 23%), evaluation and follow-up
tered year round in a computerized testing center. You (approximately 24 questions, or 17%). The Web site
are permitted 3.5 hours to answer 200 questions. Plan and handbook also provide a list of knowledge areas

chapter 1: ACHIEVING SUCCESS ON A CERTIFICATION EXAMINATION 7
for the FNP and AGPCNP exams. Examinees must be about cultural differences and cross-cultural commu-
able to integrate knowledge of pathophysiology, psy- nication, will be integrated with content concerning
chology, and sociology with the assessment, diagnosis, specific aspects of diagnosis, pharmacology, and dis-
and treatment of patients in primary care. Knowledge ease management.
of health promotion and disease prevention, as well as Questions testing physical assessment and
management of acute/episodic and chronic illness in history-taking skills, as well as content from advanced
the primary care setting, are tested. physical assessment, remain prominent. Although a
The AGPCNP examination tests knowledge of certain amount of basic pharmacological content is
adolescent, adult, and geriatric primary care; the FNP included, the latest drugs and pharmacological inter-
examination tests clinical knowledge of prenatal, ventions may not always appear because the examina-
pediatric, adolescent, adult, and geriatric primary care. tion questions are prepared and tested well in advance.
These examinations use growth and development (Note: Questions about your knowledge of safe pre-
as the basis of age-related changes, and specific age scribing for pregnant women almost always appear on
parameters are not defined for any population. the FNP examinations.)
These AANPCP examinations have a pass rate Be careful in applying your experiences from
of 87.5% for FNP and 85.7% for AGPCNP according clinical activities as a student or as a newly certi-
to 2014 data. They are also computer-based examina- fying APRN. The correct answer and other answer
tions offered year round. You know whether you have choices—also referred to as “distractors”—will not
passed or failed at the end of the examination. necessarily correlate with what you’ve currently seen.
Remember, the examination reflects the ideal answer
according to the references used and the expert pan-
Achieving Success els of the certifying body; this ideal answer may not
always mirror the realities of specific practices. Test
Nurse practitioner programs often focus on assess- answers are drawn from national guidelines and stan-
ment, management, and evaluation of disease. Indeed, dards of practice promulgated by a variety of bodies.
this is the role most of you perform in your respec- New national guidelines or standards may take up to a
tive work settings. The ability to diagnose and treat year for questions to be developed, piloted, and then
disease is paramount to your safe and effective func- included in the exam. The questions on the examina-
tioning as an APRN, and certification examinations tion are looking for generalized responses and might
increasingly reflect this reality. However, it is import- well reflect phenomena that you have not seen. Allow-
ant never to lose sight of the fact that these exam- ing yourself to become frustrated with the distractors
inations are certifying your abilities as an APRN and will not help you but rather will hinder your ability to
as such have an underlying commitment rooted in succeed. This is why it is essential that you study large
nursing-based knowledge, health, health promotion, numbers of sample test items (see chapter 2).
and human responses to health and illness. This is Being test savvy and succeeding on a multi-
especially apparent on the TCO of the ANCC example-choice examination is a far different skill from the
ination. Fully 37% of content is labeled “Foundations expert skills you bring to your practice. These skills
of Advanced Practice.” are not mutually exclusive. It is a matter of having the
As an APRN, your reaction to the various correct mind-set—one predicated on an awareness of
manifestations of health and illness phenomena is the nursing base of the certification examination cou-
instinctively different from that of other primary pled with an understanding of the test blueprint. Be
care providers. This comes up in different ways on determined not to select an anecdotal answer based
each examination, but it is an important distinction on experience from your practice experiences but
to keep in mind as you ponder the various ques- rather to select an answer based on nationally recog-
tion responses and wonder what answer is the best. nized, clinically based guidelines and rooted in clinical
Similarly, the test blueprints and types of questions literature.
asked reflect a continued commitment to concepts of You have taken the first step toward certification
health promotion and disease prevention as well as by purchasing this book. Understand the essential
to the underlying principles of therapeutic commu- reasons to become nationally certified. Fix the end
nication skills that are so essential to forging mean- goal vividly in your mind. Imagine how you will feel
ingful APRN-client relationships. Nursing-based when you receive that message on the screen saying
elements of growth and development, nutrition, and PASS, knowing that you are a nationally certified
therapeutic communication, as well as questions APRN.

Take the next step on the road to success by American Academy of Nurse Practitioners Certifi-
turning to chapter 2. It will assist you in the devel- cation Program description: http://www.aanp.org/
opment of important test-taking skills and pro- education/aanp-certification-program
vide guidelines for creating your individualized American Nurses Credentialing Center certification
study plan. Web page: http://www.nursecredentialing.org.
Dunphy, LM, Winland-Brown, JE, Porter, BO, and
References Thomas, D: Primary Care: The Art and Science of
Advanced Practice Nursing, ed 4. FA Davis, Phila-
Advanced Practice Registered Nurse Consensus delphia, 2015.
Model for Regulation: http://www.nonpf.org/default National Organization of Nurse Practitioner Faculties:
.asp?page=26 http://www.nonpf.com/

Chapter 2: Test-Taking Skills and
Designing Your Study Plan for APRN
Certification
Study Habits: Know Yourself
What Is Your Preferred Learning Style?
Active Versus Passive Studying
Getting Started
Tips for Studying
Nature of the Exams

Test-Taking Skills: An Acquired Art
General Strategies
Basic Tools
Specific Strategies
Designing Your Study Plan

Assess and Diagnose
Plan and Implement
Evaluate
Last-Minute Preparations: Relaxed and Ready

References
Lynne M. Dunphy
and Gary Laustsen
This chapter has several parts. The first part actively

assists you in assessing your study and testing style. It Study Habits: Know Yourself
prepares you to develop an individualized study plan
that will enable you to achieve your goal: becoming a There are several approaches to developing good study
nationally certified advanced-practice registered nurse habits and effective test-taking skills. Among them are
(APRN). Another part reviews the nature of the adult- recognizing what your preferred learning style is, real-
gerontology primary care nurse practitioner and family izing the importance of active versus passive studying,
nurse practitioner certification examinations (we use the and following basic tips for getting started and devel-
term “exam” from this point on) and how that translates oping test-taking skills.
to actual test questions. The remaining parts deal with
the specifics of answering multiple-choice test questions WHAT IS YOUR PREFERRED
and the skills necessary to succeed on a multiple-choice
LEARNING STYLE?
exam. Evaluating test-taking skills, developing a for-
mal study plan, and being ready on exam day are also Awareness of your learning style will guide you in
covered. selecting study strategies. Learning styles are related

to the pathways or channels through which you pre- channel. Think about which of the three learning styles
fer to absorb information. The three types of learners discussed works best for you. Time is often at a premium
are commonly identified as visual, auditory, and tactile for nurses studying for certification, and capitalizing on
(sometimes called kinesthetic). your preferred learning style will help you study in the
most efficient way. Keep strategies for your preferred
Visual Learners learning style in mind as you develop your study plan.
Visual learners learn better from reading and writing

than from hearing and talking about information. ACTIVE VERSUS PASSIVE STUDYING
They usually find background noise, such as music and Regardless of your personal learning style, the more
television, distracting rather than helpful. Following actively you are engaged in the material, the better
are strategies for visual learners: your ability to retain and comprehend content. For
• Read texts in a quiet place. example, many of us have had the experience of read-
ing an entire chapter, or listening to a review CD, only
• Watch appropriate videos.
to find that our mind drifted away sometime earlier
• Use visual study aids such as concept maps, and we have difficulty recalling even the most basic
flash cards, and charts. information. Time is a precious commodity, so it is far
• Use highlighting markers or colored paper to more efficient to learn actively the first time than to
take notes. reread or relisten to an entire chapter a second time.
Tips used to improve active learning include taking
Auditory Learners notes while reading and pausing after each heading or
subheading to summarize the content. Can you iden-
Auditory learners grasp information most effectively tify the main idea that the author was attempting to
by listening and talking. Combining information with impart? Did you pass over new terms without taking
music often works well for auditory learners. Following the time to become familiar with them? As you read a
are strategies for auditory learners: summary, do you realize that you really need to go back
• Read texts aloud. to a more detailed reference because your knowledge
is insufficient? Although active engagement may slow
• Listen to audiotapes of course material. you down initially, it will save you time in the long
• Make up a song about the content and sing run because now you are involved in active learning
it aloud (especially helpful for assimilating and not simply hoping that something will stick as you
difficult content). speed by.
• Listen to background music or other noise.
• Talk about the content with a study partner. GETTING STARTED
Studying, like regular exercise, is good for the brain.
Tactile or Kinesthetic Learners As a health-care professional, you will find that it will
Tactile or kinesthetic learners prefer to learn “hands always be your job to keep abreast of the professional
on.” They have difficulty sitting still for long periods. literature and spend some time studying. To recer-
During study sessions, they should stand and move tify, you are mandated to keep your practice current
around or take frequent stretch breaks. Integrating through a combination of clinical hours and continu-
physical activity with study works well for these learning education options. The earlier you begin to plan
ers. Following are strategies for tactile learners: for certification or recertification, the better.
The principles of effective study are simple—
• Move around while studying. worthwhile studying takes time and effort. And in
• Read while exercising on a stationary bicycle. today’s world, time is a precious commodity. There-
• Listen to tapes of learning material while fore, if you want to study, you need to set aside ade-
walking or biking. quate time and plan accordingly. Be prepared to delay
the start of new projects until this one is complete and
• Rewrite or type notes.
you have successfully taken the exam. There is no way
Although almost everyone is capable of learning around the hours involved. There are no shortcuts.
through all their sensory pathways, most have a preferred But you need to make it easy to begin.

chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 11
TIPS FOR STUDYING preferable. Study for short periods with frequent
breaks.
Just as a cold engine will run a little rough, settling
down to study when one is out of the habit can be dif- • Integrate whatever learning modalities
ficult. The following suggestions should make it easier work best for you. For example, if you are an
to begin studying and to return to it on a regular and auditory learner, use recordings. Listening to
consistent basis. recordings while you are walking is especially
good for tactile learners.
• Create a pleasant personal environment. • Think in terms of “bite-size” pieces and
This is a very basic but frequently overlooked structure your study plan accordingly. Use the
requirement for successful study. Organize “salami” principle: Cut large tasks into smaller
all your study materials in one area. Try to ones and digest them one at a time. This will
create a pleasant and regular work space for keep you from becoming overwhelmed and
yourself. Perhaps it will be just part of a room, defeated before you begin.
but make it an inviting part. Decorate it with
• Variety is essential. For example, divide
flowers, pictures, or whatever makes the area
your time between test question review and
appealing to you. For the kinesthetic learner,
content review, or break up the study period
an open area that allows free movement may
into a variety of different tasks. Take notes for
be better than a small office. Some literature
part of the time and read for part of the time.
suggests that playing classical music, especially
Do not keep at any one activity—even your
from the baroque era, in the background
practice exams—for longer than 45 minutes.
increases concentration and retention. Decide
Try studying with a study group part of the
whether background music is helpful for you or
time. Discussing the materials with others is an
distracting. Background music may be helpful
especially good strategy for auditory learners.
for an auditory learner, whereas a visual learner
Although a 45-minute session is ideal for most
may find it a distraction.
of your study time and for taking practice
• Plan your activities in advance and be exams, it is helpful to experience at least one
realistic. Plan in advance what you are going to practice exam with many questions (~150) to
work on and do not be overly ambitious. Blocks get a sense of what it will be like when you take
of 1 hour at most are recommended, with a the actual certification exam.
10-minute break every 45 minutes. List the
• Study with your purpose in mind—in this
tasks beforehand; otherwise, you might spend
case, passing the certification exam. Research
valuable time trying to decide what material
has shown that two-thirds of your study time
to review. Set specific targets for the time
will be most effectively spent taking sample test
available.
questions. Do not lose sight of this! Studying
• Keep focused on the goal: becoming certified! does not necessarily mean sitting and reading
Keep the benefits of studying clearly in mind—in textbooks. Reading books in a linear fashion
this case, the joy of receiving your passing score, is often not the most effective way to master
followed by your embossed certificate in the information. Always keep the end result in
mail. Visualize and imagine what it will feel like mind.
when you read the word PASS on the computer. • Leave the environment in readiness for your
Picture the certificate framed and hanging in next session. Leave your work environment
your office. Focus on these results and how they inviting for the next time. Put your materials
make you feel. Close your eyes and allow the away so that they are easily accessible. Do not
feelings to flood through you! leave the area cluttered; instead, make it more
• Use your knowledge of yourself and of basic pleasing. Spend the last few minutes of your
tips. There are a number of ways you can study time tidying up so that your environment
make studying more fun. Make use of your best is all set for your next session. This is also an
time of day. For some, this might mean rising excellent time to plan what you will do the
early while the rest of the household sleeps next time you sit down to study. Believe it or
and stealing time alone, undisturbed, with a not, these small, concrete habits can make a big
hot cup of tea or coffee. For others, evening is dent in your natural tendency to procrastinate.

• Reward yourself. Last but not least, reward Plan time to familiarize yourself with the technol-
yourself! Reward yourself for each study period. ogy before the exam begins. There are simple tutorials
You might decide that if you spend 3 hours to “warm you up,” helping you feel more comfortable
studying on Saturday, you will see a movie with the computerized format before beginning the
on Saturday evening or go to the mall or actual exam questions.
treat yourself to a special activity! Be good to
yourself.
Now that you understand yourself better and know Test-Taking Skills: An Acquired Art
how to approach studying for the exam, we move on
to providing some specific information about the cer- The ability to select the best response to each question
tification exams. is what determines your success on the exam. Knowl-
edge of the content is, unfortunately, not enough to
guarantee success. If you are not able to communicate
your knowledge through the medium of the exam, you
Nature of the Exams will not succeed in becoming certified. Succeeding on
a certification exam is not always indicative of your
The ANCC exam consists of 175 scored questions and actual practice ability or intellectual capability.
25 items being piloted that do not count in your score.
The AANP certification exams consist of 150 scored
multiple-choice questions, 15 of which are pilot ques- GENERAL TEST-TAKING STRATEGIES
tions. The exam is administered on a computer at a
Some general principles apply to preparing for and
testing center, and you will know within a few minutes
taking any sort of standardized test, regardless of the
after you complete the exam if you have passed. The
content area. Familiarize yourself with these strategies
questions are at a variety of difficulty levels, adminis-
listed in Box 2-1.
tered in an integrated format. The exams are not com-
puter adaptive at this time. Computer-adaptive testing
is the technique used for the NCLEX-RN licensure
exam. With computer-adaptive tests, each answer, Box 2-1: General Strategies
correct or incorrect, determines the difficulty level of
the next question a participant receives, and each par- • Avoid changing answers.
• Develop a self-confidence mantra to recite if you
ticipant may answer a different number of questions to find yourself doubting your knowledge.
meet a minimum passing level. • Develop and stick to a study plan; avoid last-minute
The AANPCP exam as of this writing is com- cramming.
posed of multiple-choice questions only. The ANCC • Do not linger too long over one question.
exam includes four types of questions: (1) multiple • Focus on concepts, not details, during study
periods.
choice, (2) multiple response, (3) drag and drop, and
• Focus on decreasing your test-taking time.
(4) hot spot. Most of the test questions are multiple • Maintain objectivity; avoid adding your own
choice. If you are planning to take the ANCC exam, interpretation.
it would be helpful to review on the ANCC Web • Read all answer options.
site examples of the alternative type questions. This • Read questions as though you are speaking them
format means that you must be able to identify key aloud in your head to avoid scanning.
• Time yourself in practice tests; allow 45 to 60
words or phrases on a computer screen, not on the seconds for each question.
traditional paper format. Many test takers feel con- • Use concept maps.
strained when they are unable to underline or high- • Use practice tests to increase confidence.
light key words and phrases. A helpful tip: Use the • Work on self-confidence.
scratch paper and pencil provided to you when taking
Source: Adapted from Sides, MB, and Korchek, N:
a computer-based exam to write down the key phrases Successful Test-Taking Strategies, ed 3, Lippincott Williams
if that helps you focus on the topic and/or issue being & Wilkins, Philadelphia, 1998, p. 77; and Dickenson-Hazard,
presented in the question. Remember that the scratch N: Test-taking strategies and techniques. In Kopac, CA,
and Millonig, VL (Eds), Gerontological Nursing Certification
paper is collected by the testing center staff before you Review Guide, revised ed, Health Leadership Associates,
may leave the testing area; this is done to maintain Potomac, MD, 1996, pp. 3–5.
test question security.

Achieving success on a multiple-choice test is a skill; you with a choice between assessment and implemen-
and like any other skill, it can be improved. Remember tation, you should remember these basic tips. The
how you improve other skills, such as playing an instru- purpose of assessment is to validate or confirm the
ment or a sport: practice. The same holds true for test- problem. When considering an answer choice that
taking skills. The best way to succeed on the exam is is an assessment, you should ask yourself, “Is this
through practice, practice, and more practice. an assessment that is appropriate to the topic of the
The more you practice answering sample test ques- question?” If it is, you should carefully consider this as
tions, the better you will become at it. That is why a very likely answer choice. If, however, you believe
we have written this book for you. This book provides the correct answer choice is an implementation, you
over 2,000 sample test questions. Research has shown should ask yourself, “Do I have enough information
that two-thirds of study time should be spent taking to implement what the answer choice is asking me
sample tests, and one-third of the time should be spent to do?” Last, if the answer choice is asking you to
reviewing content. A number of exam-preparation evaluate a situation, you should ask yourself, “What
books are available to you; however, very few contain would be the outcome if I choose this answer?” The
nearly the number of test questions you need to develop criteria for reference are always your textbook and/or
and flex your test-taking muscles. This book provides professional guidelines, and you should avoid answer
enough questions to enable you to do that. Addition- choices that are too narrow or reflective of an indi-
ally, reading through the answers in the rationales— vidual practice preference. Each exam publishes a set
the why of the reason the selected answer is correct or of textbook references that are used in the creation
incorrect—is an excellent way to expand your knowl- of the exam questions. It is a good practice to review
edge base in general. It also provides insight into how this list of text references.
answers are keyed—why one answer is rated as correct
over another answer that seems to make more sense
Maslow’s Hierarchy of Needs
to you. Remember: You will not be able to argue with
the certifying exam creators as to your theory about Another important tool is Maslow’s hierarchy of needs.
why one answer is “more correct.” Allow yourself to It is particularly helpful in making priority decisions.
“tune in” to these rationales so that you become more According to Maslow, there are five levels of human
familiar with the answers that are noted to be correct. needs: physiological needs, a need for safety and secu-
In addition to the general strategies for test taking rity, a need for love and a sense of belonging, a need for
listed earlier, there are specific tools and strategies to self-esteem, and a need for self-actualization. Because
strengthen the test-taking skills you will need for certi- survival is grounded in basic physiological needs, these
fication. We will review two nursing tools and give you needs take priority over any other human needs. It
some specific strategies for how to use them in testing comes down to practicality: If you do not have oxygen
situations. to breathe or food to eat, your focus is not really on the
stability of your love life. When trying to determine
the priority between a physiological need of a client
BASIC TOOLS
versus a psychosocial need, remember the priority is
Two basic tools that are used in nursing—and that you to meet the physical needs of the client. This doesn’t
should employ when taking the certification exam—are imply that the correct answer is never psychosocial; it
the nursing process and Maslow’s hierarchy of needs. simply means that survival of the species requires us
to address physiological needs first, before we advance
through the other stages of human needs. Always
The Nursing Process
think ABCs—Airway, Breathing, Circulation. Care-
The nursing process is a great tool when taking your fully evaluate each item and ask yourself “What level
certification exam because it can guide you through of need is the question addressing? Physiological? Need
problem-solving. The AANP certification exam for self-esteem?”
structures very specific pieces of information around
these areas (see the table of contents on the Web
SPECIFIC STRATEGIES
site). As you recall from your basic nursing educa-
tion program, the steps of the nursing process include The following specific strategies should help in
assessment, diagnosis, planning, implementation, answering the multiple-choice questions on the cer-
and evaluation (ADPIE). When a question provides tification exam.

Strategy #1: Understand and Analyze the is in the form of an incomplete statement, is in bold
Anatomy of a Test Question print.
A multiple-choice test question consists of three parts: EXAMPLE 1
• An introductory statement, which sets up the A 32-year-old woman comes to your office for a routine
clinical scenario examination. Her blood pressure is 116/74. You should
• A stem, which poses a question or incomplete recommend that the client have her blood pressure checked
sentence again in
• Options, from which you must select the correct
A. 6 months.
answer
B. 1 year.
The first step in analyzing a multiple-choice test
C. 2 years.
question is to separate what the question tells you from
what it asks you. The introductory statement, which D. 5 years.
may vary considerably in length, provides informa-
tion about a clinical scenario, a disease process, or a The first and most important step is to identify what
nursing response. The stem poses a specific question, the question is asking. You cannot expect to answer the
which you must answer on the basis of your advanced- question correctly until you understand the topic of
practice nursing knowledge. Stems are worded in dif- the question. The introductory statement of Example
ferent ways but always contain enough information to 1 gives you information about the clinical situation—a
answer the question. Some stems are in the form of 32-year-old female client came to your office for a rou-
a question; others are in the form of an incomplete tine exam and has a normal blood pressure; these are
statement that you must complete. You must then the topics. The stem asks you for a clinical judgment
select the one option that best answers the question based on your knowledge of clinical guidelines—when
or completes the incomplete statement from a num- should she have her blood pressure checked again? You
ber, usually four, of potential options, sometimes called must select the option that provides the most accurate
distractors. response—in this case, option C is correct according
Here are a few additional considerations in under- to current guidelines. This question is an example of
standing the format of questions: a recall (memory-based) question, sometimes called
a knowledge-based question. You need to know and
1. Answer options on certification exams will recall the guidelines concerning the frequency of blood
not include “All of the above” or “None of the pressure measurements under different circumstances
above.” and within different populations.
2. Answer options often have very similar Other test questions assess comprehension.
wording with only a few of the words or This is defined as “drawing inferences from informa-
phrases distinguishing the correct answer from tion without necessarily relating inferences to other
the incorrect options. material”—in other words, using only the information
3. Questions are not phrased “negatively.” That that is present in the question. Test takers often fall
means you will not have to choose an answer in into the trap of “reading into” these types of questions—
which the correct response is not to do something. thinking about information that is not requested in the
question.
4. Abbreviations (except a few standard ones) are
always spelled out. EXAMPLE 2
5. There are no fill-in-the-blank questions.
A 41-year-old man comes to your office complaining of
6. Generic drug names are used with some trade having hit his head. While assessing his eyes, you note that
names appearing in parentheses after the the left pupil constricts simultaneously when the right pupil
generic name. Don’t learn just trade names. receives direct light. His left pupil exhibits which reaction?
Knowing these components will assist you in ana- A. Direct papillary reaction
lyzing the information presented and in focusing on
B. Consensual papillary reaction
the question’s intent or issue. Let’s look at an example
that includes an introductory statement in the form of C. Convergence reaction
a clinical scenario. The stem, which in this example D. Corneal light reflex reaction

In this case, the correct answer is option B. You Strategy #2: Identify the Questions, Critical
were able to comprehend the requested information Elements, and Key Words
based on the exact information given in the question.
Nursing, however, is a practice-based discipline. The ability to identify the critical elements and key
Nurses must apply knowledge to specific situations. words in a test question is crucial to a correct inter-
This ability is assessed through the application ques- pretation of the question. Critical elements, such as
tions designed to assess your ability to implement, the key concepts and conditions, tend to appear in
solve a problem, or perform a task. Application of the introductory statement, whereas key words usually
nursing knowledge is essential to safe, competency- appear in the stem of the question. Regardless of the
based, entry-level advanced nursing practice. Appli- placement of these words, remember that everything
cation sometimes implies analysis of information, you need to be able to answer this question correctly is
meaning the question requires you to dissect and ana- provided for you.
lyze information and/or distinguish between relevant Key words are important words or phrases that
and irrelevant data. The certification exam is a test help focus your attention on what the question is spe-
of “minimum competency,” and simply recalling facts cifically asking. Examples of key words include most,
would not provide the certification bodies with suffi- first response, earliest, priority, on the first visit, on a sub-
cient information to determine your abilities. As such, sequent visit, common, best, least, immediately, and ini-
you can expect the majority (up to 75%) of questions tial. Take a look at this example.
to be application and analysis type questions. These
require you to integrate knowledge with the facts that EXAMPLE 4
are presented in order to choose the single best answer Which of the following is an example of a primary preven-
for each question. Review the following example. tive intervention?
EXAMPLE 3 A. Blood pressure screening
Julie, age 18 months, is up to date with her immunizations B. Pap smear
and is due to receive her diphtheria, tetanus, and acellular C. Screening sigmoidoscopy
pertussis (DTaP) and polio vaccinations today. Her father D. Tetanus prophylaxis
is bedridden at home with AIDS. Which immunizations
should Julie receive today? Example 4 is a recall question with a positive-
response stem. Although all the interventions are
A. DTaP only
preventive, the key word is primary, allowing you to
B. DTaP and inactivated polio vaccine (IPV) choose the correct answer, option D.
C. DTaP; IPV; and measles, mumps, and rubella After identifying the topic of the question, you
(MMR) must also identify the issue the question is asking
D. DTaP, OPV (oral polio vaccine), and MMR about. For example, the question, as in Example 5,
may be requesting information about a disorder.
You must synthesize several concepts regarding
immunizations to select the correct answer (option B) EXAMPLE 5
for this question. You must integrate your recall knowl-
Mr. Williams, age 76, is seen in the ambulatory care clinic.
edge regarding standard and current immunization
He is complaining about incontinence, suprapubic pain,
schedules (e.g., that Julie should receive DTaP and
urgency, and dysuria. A urinalysis reveals the presence of
polio immunizations on this visit) with the specific
white blood cells (WBCs), red blood cells (RBCs), and
clinical scenario.
bacteria. What is your diagnosis?
A common error test takers make in a multiple-
choice testing format is to analyze the question and A. Pyelonephritis
choose the answer with their eyes. Analysis is, how-
B. Nephrotic syndrome
ever, done with the brain. Be careful of choices that
“look good.” The reference for every correct answer C. Benign prostatic hypertrophy (BPH)
is grounded in textbook and/or professional guideline D. Cystitis
knowledge. A common trap that test question writers
use is to include answer choices that appear on the sur- By selecting the correct answer, option D, you
face to be correct but are not. have demonstrated knowledge related to a disease

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southern part of the country and the adjoining regions of Japan,
especially the island of Tsushima. But in this trade Korea parted with
its gold, out of which the Japanese themselves were subsequently
cheated by the Dutch, who took it off to Holland. Thus neither of the
nations in the Far East was enriched in any permanent way; both
were the rather impoverished as respects their store of resources for
the future.
Under the Japanese, Mr. Townsend was confident—as is every one
acquainted with the past and present conditions—that there would
soon be a very considerable development of the country’s resources.
This would take place especially in the lines of silk-culture, raising
rice and beans, and grazing and dairy products. For all these forms
of material prosperity the country was by soil and climate admirably
adapted. Up to this time the rinderpest had been allowed to ravage
the herds unchecked. In a single year it had carried off thousands of
bullocks, so that the following spring the entire family of the
peasants would have to join forces—men, women, and children—to
pull their rude ploughs through the stiff mud. As to the culture of
fruit, the outlook did not seem so hopeful. The market was limited;
the various pests were unlimited in number of species and
individuals, and in voracity. A certain kind of caterpillars eat pine-
needles only; and some gentlemen, in order to protect the pine-
trees in their yards, were obliged to hire Koreans to pick these pests
off the trees, one by one, by the pailful at a time. It seems to me,
however, that in time these difficulties may be overcome by the very
favorable character of soil and climate for many kinds of fruits, by
the possibility of ridding the country of the pests and of improving
the already excellent varieties of fruits, and by the development of
the canning industry.
As to the effect of the Japanese Protectorate upon the business of
foreign firms, Mr. Townsend assured me that the honorable firms
were pleased with it and considered it favorable to the extension of
legitimate business. Unscrupulous promoters do not, of course,
enjoy being checked by the Resident-General in their efforts to
plunder the Korean resources. In this conversation with Mr.
Townsend I learned the details of one of those dishonorable
promoting schemes which have been, and still are, the disgrace of
some of the foreign residents in Korea. But this is not the worst of
them. They become the disgrace of the countries from which the
promoters come, so often as the latter can successfully appeal to the
consuls or other diplomatic representatives of their nationals for
official support in their nefarious schemes.
The relations, both business and social, between the Japanese
and the Koreans in Chemulpo are now much improved. Indeed,
there is at present an almost complete absence of race-hatred
between the two. Formerly, on some trifling occasion of a quarrel
started between a Japanese and a Korean, an angry mob of several
hundred on each side would quickly gather; and unless the other
foreigners interfered in time, there was sure to be serious fighting
and even bloodshed. But the growing number of those belonging to
both nations who understand each other’s language and each other’s
customs has almost entirely done away with the tendency to similar
riots. Indeed, a positive feeling of friendliness is springing up
between certain individuals and families of the two nationalities. All
of which tends to confirm the statement of another business man—
this time of Seoul, where the hatred of the Koreans for the Japanese
is studiously kept aglow by Korean officialdom and by selfishly
interested foreigners—that in fifty years, or less, no difference would
be known between the two. There will then, perhaps, be Koreans
boasting of their Japanese descent and Japanese boasting of their
Korean descent; and a multitude of the people who will not even
raise the question for themselves as to which kind of blood is
thickest in their veins. Everywhere on the face of the earth
ethnology is teaching the lesson that “purity” of blood is as much a
fiction as is the so-called “primitive man.”
According to Mr. Townsend, one cause of the deforestation of so
large regions of Korea in former times was the fear of tigers; this
fear was, of course, greatly increased by the fact that the
Government did not dare to entrust the people with firearms. The
tiger-hunters were, it will be remembered, a species of officials who
composed the bravest, and oftentimes the only brave, troops in the
king’s army. As late as about sixty years ago the principal road to
Pyeng-yang from Seoul passed through a stretch of dense forest
infested with tigers. As long as the slaughter by these beasts did not
average more than one man a week, the people thought it could be
borne; but when the number killed in this way rose to one or two a
day, they applied to the Tai Won Kun, and permission was given to
cut down the forest.
The prevalence of the tiger and also the method of governmental
control over their capture and over the sale of their skins is well
illustrated by the following amusing story. Recently, a foreigner who
was fond of hunting big game, brought a letter of introduction to Mr.
Townsend and asked him to negotiate for him with two tiger-hunters
for a trip to the region of Mokpo. Knowing well the Korean character
as respects veracity, it was necessary for the inquirer to discover in
indirect ways whether the men were really courageous and skilful
hunters, as well as whether tigers were really to be met in the
region over which it was proposed to hunt. Something like the
following conversation then took place:—“You claim to be brave
tiger-hunters, but have you ever actually killed a tiger?” “Yes, of
course, many of them.” “But what are you hunting at the present
time?” “Just now we are hunting ducks.” “How much is a tiger worth
to you when you succeed in getting one?” “Well, if we can have all
there is of him—the skin, the bones” (which, when powdered, make
a medicine much prized by the Chinese on account of its supposed
efficacy in imparting vigor or restoring strength), “and all the rest,
we should make at least 110 yen.” “Why, then, do you hunt ducks
which bring you so little, when you might kill tigers, which are worth
so much?” “Yes, but if I kill a tiger, the magistrate hears of it and
sends for me; and he says: ‘You are a brave man, for you have killed
a tiger. You deserve a reward for your courage. Here are five yen;
but the tiger, you know, belongs to the Crown, and I will take that in
the name of His Majesty.’ Now do you think I am going to risk my life
to earn 120 yen for the magistrate, who squeezes me enough
anyway, and get only 5 yen for myself?”
“But, tell me truly, are there really tigers to be found in that
neighborhood?” “Yes, indeed, there are.” “How do you know that?”
“Why, just recently two men of the neighborhood were eaten by
tigers.” “Indeed, that is certainly encouraging.” “It may be
encouraging for the foreign gentleman who wishes to hunt the tiger,
but it was not very encouraging for the Korean gentlemen who were
eaten by tigers.” The grim humor of all this will be the better
appreciated when it is remembered how omniscient and omnivorous
are the Korean magistrates as “squeezers”; and how large the
chances of the tiger are against the hunter, when the latter is
equipped only with an old-fashioned musket and a slow-burning
powder which must be lighted by a fuse.
A story of a quite different order will always attach itself in my
memory to the name of Chemulpo. During the Chino-Japan War one
of the missionary families, now in Seoul, was living in the part near
the barracks where the Japanese soldiers were quartered until they
could be sent by sea to the front. One day a petty officer came up
on the porch of the house, uninvited; but after accepting gratefully
the cup of tea offered to him, being unable to speak any English, he
went away, leaving the object of his apparent intrusion quite
unexplained. Soon after, however, he returned with some twenty of
his comrades, mostly petty officers, accompanying him; and when
the hostess was becoming somewhat alarmed at the number for
whom she might be expected to furnish tea and cakes, one of the
company, who could best express their wishes in the foreign
language, revealed the motive of the soldiers’ visit. He explained in
broken English that they had come to see the baby—a girl about two
years old. The little one was then brought out by the mother and
placed in the arms of the speaker, who carried the child along the
line formed of his comrades and gave each one a chance to see her,
to smile at her, and to say a few words to her in an unknown
tongue. On going away, after this somewhat formal paying of
respects to “the baby,” the Japanese officer still further explained:
“Madam,” said he, “to-morrow morning we are going to the front
and we do not expect ever to return. But before we go to die, we
wanted to bid good-by to the baby.” In the Russo-Japanese war
nothing else so cheered the soldiers of Japan on their way to the
transports for Manchuria as the crowds of school-children at all the
railway stations, with their flags and their banzais. The number of
the regiment to which these soldiers, who bade good-by to the
American baby before they went forth to die, was taken note of by
the mother. Their expectation came true; they did not return.
The only other excursion by rail from Seoul which we made during
our visit to Korea was to attend the formal opening ceremony of the
Agricultural and Industrial Model Station at Suwon. The history of its
founding is copied from the account of the Seoul Press:
Shortly after the inauguration of the Residency-General last

year, the Korean Government was induced to engage a
number of Japanese experts well versed in agriculture and
dendrology with a view to the organizing and conducting a
school for training young Koreans in the principles and
practice of scientific husbandry and forestry. The
establishment of such a school was absolutely necessary in
order to insure success to the work of improving agriculture
and forestry, to which the Resident-General wisely attached
great importance.
At the suggestion of these experts, it was decided to
establish the school in question at Suwon, on a site adjacent
to the Agricultural and Industrial Model Station there, the
proximity of these two institutions being attended by various
obvious advantages. The school-buildings and dormitories,
together with houses for members of the faculty, were
erected at a total outlay of a little over 44,000 yen, being
completed by the end of 1906.
Pending the completion of the buildings, instruction was,
for the time being, given in the class-rooms of the former
Agricultural, Commercial and Industrial School at Seoul from
the 10th of September, 1906. The last-mentioned school had
been established a few years ago under the control of the
Department of Education. Its organization was too imperfect
to make it possible for it to attain the object for which it was
established.
Early this year the School of Agriculture and Dendrology
removed to its new quarters at Suwon. The post of principal
is filled by the director of the Agricultural Bureau in the
Department of Agriculture, Commerce and Industry. The
teaching staff consists of five professors (Japanese) and two
assistant professors (Koreans).
There are two departments: (1) the Ordinary, and (2) the
Special. The Ordinary Department extends over two years
and the Special Department one year. The latter Department
consists of two separate courses, namely, agricultural and
dendrological. These courses are open to such of the
graduates of the Ordinary Department as may desire still
further to prosecute their studies in their respective special
branches. Besides the above-mentioned departments, there is
a practical training course for giving elementary instruction in
some special subjects connected with agriculture or forestry.
The term is not more than one year.
It may be interesting to tabulate the various subjects
taught in the respective departments. They are as follows:
Ordinary Department:—Morals, Japanese, Mathematics,
Physics and Meteorology, Natural History, Outlines of
Agriculture, Soil and Manures, Crops, Dairy Produce,
Sericulture, Agriculture, Agricultural Manufacture, Outlines of
Dendrology, Outlines of Afforestation, Outlines of Veterinary
Medicine, and Political Economy and Law.
Special Department (Agricultural Course):—Soil, Manure,
Physiological Botany, Diseases of Crops, Injurious Insects,
Dairy Produce, Sericulture and Spinning of Silk Yarns,
Agricultural Manufactures, and Agronomy.
Special Department (Dendrological Course):—Dendrological
Mathematics, Afforestation and Forest Protection, Forest
Economy, Utilization of Forests, Forest Administration.
Instruction in these subjects is given through the medium
of interpreters, the last-mentioned office being fulfilled by the
Korean Assistant Professors. The number of students fixed for
the respective departments, is 80 for the Ordinary, and 40 for
the Special Department, the number for the practical Training
course being fixed each time according to the requirements.
The number of students at present receiving instruction is 26
in the Ordinary Department, and 12 in the Practical Training
course. It is very satisfactory to learn that these students are
highly commended for obedience, good conduct, and
industry. This promises well, not only for the success of the
school, but for the progress of the nation.
This lengthy account of the founding and progress of the school

and station, whose opening ceremonial was to be celebrated on
Wednesday, May 15, 1907, is given because of the great importance
of the relation which every such enterprise sustains to the lasting
success of the Japanese Protectorate and to the welfare of Korea
under this Protectorate. Hitherto, the considerable sums of money
which have been from time to time obtained from the Korean
Government to found and to foster schemes for improved education
or industrial development have almost without exception been
unfruitful expenditures. The appropriation has either been absorbed
by the promoters of the schemes, or if really spent upon the objects
for which it was appropriated, both interest and care have ceased
with the spending of the money. Even the missionary schools, which
have up to very recent times afforded the only means for obtaining
the elements of a good modern education—valuable as they have
been, especially as means of propagandism—have too often resulted
in sending out graduates who, if they could not get the coveted
official positions, were fit for nothing else. In Korea, as in India—to
take a conspicuous example—the students from these schools have
sometimes become rather more practically worthless for the service
of their nation, or even positively mischievous, than they could have
been if left uneducated. But what Korea now most imperatively
needs is educated men, who are not afraid of honest work; men,
also, who will not accept official position at the expense of their
manly independence and moral character, or gain it by means of
intrigue and corruption. But “honest work” must, for a considerable
time to come, be chiefly connected with the agricultural and
industrial development of the country. Moreover, the institution at
Suwon is demonstrating that the Koreans can make good students
and skilful practitioners in the, to them, new sciences which give
control over nature’s resources for the benefit of man. The Confucian
education hitherto dominant in this country has chiefly resulted in
cultivating scholars who either sacrificed usefulness in service to the
false sentiment of honor, or else subordinated the most fundamental
principles of morality to that skill in official positions which secured
the maximum of squeezes with the minimum of resistance. And,
finally, nothing so undermines and destroys race-hatred as the
prolonged association of the two races in the peaceable relations of
teacher and pupil; or of teachers and pupils with their respective
colleagues.
Six car-loads of invited guests, belonging to all classes of the most
influential people of Seoul and Chemulpo, left the South-Gate Station
on a special train at one and a half o’clock, on that Wednesday
afternoon, for Suwon. Marquis Ito and his staff, and other Japanese
officials, Korean Ministers and their guards, all the foreign Consuls,
the principal men of business, representatives of the press, and
Christian missionaries were of the party. The day was warm, but
fine; the landscape was even more beautiful in its coloring than
usual. On arrival at the station of Suwon, the guests were met by
the Minister and Vice-Minister of Agriculture, Commerce and
Industry, by Dr. Honda, the director of the Model Station, and others,
who escorted them on foot over a newly made road through the
paddy fields belonging to the station. It did not need an expert eye
to see the immense difference, as regards economy of arrangement
and efficiency of culture, between these fields and the relatively
uneconomically arranged and unproductive fields along the railway
by which we had passed as we came to Suwon.
The Agricultural School and Station are beautifully located; the
lake, which has been made by damming a stream, with the plain
under improved cultivation, and the surrounding mountains, all
combine to produce a charming scene. On reaching the Model
Station itself a brief time for rest was allowed; this could be
improved by those who wished to inspect the rooms where the
specimens were displayed, and the laboratories of various kinds. The
ceremonial proceedings were opened by the director, Dr. Honda, who
reported the progress already made and defined the work which was
to be attempted for the future. The work was to consist in the
improvement of the quality of the seeds, the introduction and
acclimatization of new varieties of farm products, the instruction of
the farmers, the supply of manures, the effecting of improved
irrigation, drainage, and protection against inundation, the
improvement of poultry and dairy farming, the introduction and
encouragement of sericulture, and the securing of more by-products
on the farms.
After a few words from Mr. Song, the Korean Minister of
Agriculture, Marquis Ito made a somewhat lengthy address. He
spoke frankly in criticism of the failures which the Korean
Government had hitherto made in its various attempts to accomplish
anything for improving the miserable lot of the toiling millions of the
Korean people. “Not only had nothing been done to ameliorate their
condition, but much had been done to injure their interests and
aggravate their miseries. Let those who boasted of their knowledge
of Chinese philosophy remember the well-known teaching that the
secret of statesmanship consists in securing the contentment of the
people.” His Excellency then referred to the example of the great
Okubo in Japan, who founded an agricultural college there in 1875,
spoke of the brilliant results which had followed this improved
instruction and practice, and hoped that the Korean officials, in
whose charge this well-equipped institution was now placed, would
make it equally useful to the Korean people.
The ceremonial part of the day was closed by an address by Mr.
Kwon, the Minister of War, who had formerly been, although, as he
confessed, without any knowledge of such matters, head of the
Department of Agriculture, Commerce and Industry. It was indeed
fourteen years since a department had been founded for the
improvement of agriculture; but “nothing worth speaking of had
been initiated by that department.” After spending 170,000 yen on
the station, Japan had kindly consented to turn it over to the Korean
Government. He was hopeful that the change already beginning to
be felt in the interests of the farming population of his country would
in the near future result in a large improvement in their condition. [It
does not need to be said to those acquainted with the way in which
such projects for developing the resources of Korea have hitherto
been conducted, that both the grave rebuke of Marquis Ito and the
confessions of the Korean Ministers are amply warranted.]
The ceremony concluded, refreshments were served in and about
an old and historically interesting Korean building, which is situated
a few rods below the farm station and just above the nearer end of
the dam. After this, the whole company walked back to the railway
by a road laid out on the back of the dam, which is shaded with
young trees and made attractive by views of lake, fertile plains, and
hillsides and mountains in the distance on every side. On the plain
below the dam some Koreans were holding a pantomimic
celebration, or merry-making, of the sort which it is their custom to
commit to hired bands of men skilful in affording this species of
amusement. On the hillsides at the end of the dam, and above the
track of the railway, hundreds of other Koreans—adults in glistening
white and children in colors of varied and deepest dyes—were
quietly enjoying the scene. When the train stopped at the point
nearest the end of the pleasant walk, it was, I am sure, a well
satisfied crowd of guests which returned by it to Seoul.
With this ceremony at Suwon another which I had previously
attended in Seoul naturally connects itself. This was the opening of
the Industrial Training School, the initial outlay for which, including
the cost of buildings and apparatus, amounted to a little more than
110,000 yen. The significance of this enterprise will be the better
understood when it is remarked that the native workmen of to-day
make nothing whatever, with the exception of a few cheap brasses
and the attractive Korean chests, that any foreigner would be
inclined to buy. Moreover, their own tools and machinery of every
description are exceedingly crude and old-fashioned. At the
ceremony in Seoul addresses were made similar to those listened to
at the Suwon affair. Mr. Yamada, the principal of the Institute,
reported that out of the eleven hundred applicants who had
presented themselves for examination, fifty students had been
admitted. Marquis Ito and the Korean speakers dwelt upon the same
facts—namely, the deplorable backwardness of the nation in
industrial matters, the unsatisfactory results of past endeavors at
improvement, and the needs and hopes of the future. After the
addresses, the guests visited the different workshops, where the
Korean students were to be given manual training; and then
resorted to the sides of the mountain above, where refreshments
were served. The decorative features of the festivities—consisting of
the Korean crowds on the upper mountain sides, the uniformed
officials in and around the refreshment booths, and the brilliant
bloom of the cherry bushes and plum trees—were even more
striking than at Suwon. On this occasion it was my pleasure to
receive a cordial greeting from some of the Korean officials, among
whom was the Minister of the Interior, the cousin of the Governor at
Pyeng-yang. It was evident that he had heard from his cousin of the
assistance rendered directly by the missionaries and indirectly by
me, in the way of quieting the excited condition of the Korean
population at the time of our visit.
If official corruption can be kept aloof from these enterprises, and
an honest and intelligent endeavor made to carry out the plans of
the Japanese Government under Marquis Ito for the agricultural and
industrial development of Korea, there is little reason to doubt that a
speedy and great improvement will result. That the Korean common
people, in spite of their characteristic air of indifference and their
appearance of indolence, can be stirred with ambition, and that
when aroused they will make fairly industrious and apt learners,
there is, in my judgment, no good reason to deny. The experience of
the “Seoul Electric Railway,” and of other similar enterprises, favors
this judgment. Not to speak of the financial methods of this
company, and after admitting that the physical condition of its
property and the character of its service leave much to be desired, it
has been, on the whole, successful in demonstrating the possibility
of conducting such business enterprises by means of Korean labor.
Mr. Morris, its manager, who came to Seoul in July, 1899, told me
the interesting story of his earlier experiences. The working of the
road during the first years of its running was accompanied by
enormous difficulties. Neither the passengers, nor the motormen and
the conductors had any respect for the value of time; most of the
employees had even to learn how to tell time by their watches. The
populace thought it proper for the cars to stop anywhere, and for
any length of period which seemed convenient to them. If the car
did not stop, the passengers made a mad rush for it and attempted
to jump on; they also jumped off wherever they wished, whether the
car stopped or not. This practice resulted in serious bruises and
fractured skulls as an almost daily occurrence. Native pedestrians in
the streets of Seoul were not content to walk stolidly and with a
dignified strut (which is still the habit of the Korean before an
approaching Japanese jinrikisha) along the track in the daylight, with
the expectation that the car would go around them; but at evening
they utilized the road-bed by lying down to sleep on the track with
their heads on boards placed across its rails. One dark night in the
first summer three men were killed by the last trip between the river
and the city. In those days the broad thoroughfare, which is now
kept open for its entire length, was greatly narrowed by rows of
booths and “chow” shops on either side. Here the men from the
country would tie their ponies (the Korean pony is notable for his
vicious temper when excited) to the tables, and, reclining upon the
same tables, would proceed to enjoy their portion of food. When the
electric car came through the centre of the street, the beasts went
wild with fright; sometimes they dashed into the shops; sometimes
they fled down the street dragging the tables and scattering “chow”
and men in every direction. At one place the line to the river runs
over a low hill which is, in the popular superstition, a part of the
body of the rain-bringing Dragon. In a dry season the people
became greatly excited and threatened violence to those who had
brought upon them the calamity of drought by such sacrilege done
to the body of this deity. Mr. Morris had himself fled for his life
before a Korean mob who were ready to tear him in pieces to
avenge the killing of a child by the car. At the present time, however,
there were fewer accidents in Seoul than on the electric car-lines of
Japan; and many fewer than those from the same cause in the
larger cities of the United States. In one of the more recent years
they had carried 6,000,000 passengers and had only killed one. This
is certainly not a bad record; for while, on the one hand, the service
of the road is relatively slow and infrequent, on the other hand, in
Seoul there are no sidewalks and the streets are thronged with foot-
passengers and with children at play.
One other excursion from Seoul is, perhaps, worthy of record as
throwing some sidelights upon Korea—this time, however, chiefly an
affair of recreation. This was the ascent of Puk Han, the ancient
place of royal refuge in cases of revolt or foreign invasion. The party
consisted of Mr. Cockburn, the British Consul-General; Mr. Davidson,
the successor of J. McLeavy Brown in the Department of Customs;
Dr. and Mrs. Wm. B. Scranton, and Madam Scranton, the mother of
the Doctor. Mr. Cockburn and Mr. Davidson made the ascent as far as
was possible in jinrikishas, and the rest of the party in chairs carried
by four or six coolies each. By the longer way out which the party
took, there was, however, much walking (but no hard climbing) to
do; and by the shorter way home, with its much steeper descent,
there was little besides walking which could safely be done by any
one.
The actual start was preceded by the customary bargaining with
the coolies. This resulted in reducing by one-half the original charge
—only to find the head man applying late in the evening after our
return for an additional “present” direct from me, in reliance on my
ignorance of the fact that a handsome present had already been
given through the friend who made the arrangement. But, then,
such squeezes are not confined to Korea in the Far East, nor are
they peculiar to the Far East and infrequent in London, Paris, and
New York.
Under “Independence Arch,” where, as we have already seen, the
promise of a new and really independent Korea is built into the form
of a monument of stone, the whole party were photographed. At a
small village some three miles from Seoul, the coolies made another
stop; here they received their first advance of money for “chow.” In
the street of the village was standing one of those gorgeous
palanquins which serve as biers, and which give the lifeless body of
the poorest Korean his one ride in state to the hillsides where the
tombs of the dead hold the ground against the fields needed for
cultivation by the living. But these hillsides at least serve the living to
some good purpose as preferred places for recreation and for
intercourse with nature, as well as, in some sort, with their deceased
ancestors. In Korea, as in India, birth, marriage, and death are
expensive luxuries for the poor; to get into the world, to beget an
heir, and to get out of the world again, absorb all the accumulated
resources of a lifetime of toil for the average Korean. Surely, under
such circumstances, “the will to live” lays itself open to the charge of
Schopenhauer—that it is blind and working ever to the production of
increased misery. Industrial development, firmly coupled with
improved morality, and with the cheer and hopes of an elevating
religion, as a true “psychical uplift,” are the only sufficient cure for
such pessimistic tendencies.
West Gate or “Gate of Generous Righteousness.”
Among the several attempts at photographing made on the way to

Puk Han, were some intended to catch one of the numerous Korean
children who appeared puris in naturalibus. These were uniformly
unsuccessful. Pictures of this characteristic sort were not to be had
by us foreigners, although the attempts were supported by the offer
of sizable coins. At the first motion to point the camera toward these
features of the landscape, they took to their heels and fled afar with
urgent precipitancy.
Within perhaps two miles of the Outer Gate of the mountain
Fortress we were obliged to dismount, the way having become too
rough and difficult even for chairs with four coolies each. Puk Han’s
wall was built in 1711; although there is a not altogether improbable
tradition that the mountain, which is somewhat more than 2,000
feet high, was fortified long before, under the Pakje kingdom. The
gate through which one enters the walled enclosure is picturesque
and interesting. Not far inside the wall, across a little valley, are to
be seen the solid stone foundations of the new Buddhist temple
which is to take the place of one that was destroyed by fire. This is
one of several indications that the introduction of modern civilization
and of Christian missions is to be followed in Korea, as it certainly
has been followed in Japan and elsewhere, by a revival of the spirit,
and an improvement in the form and efficacy, of the older religion of
the country. Buddhism has, indeed, been for centuries largely lacking
in all moral force and spiritual satisfactions in Korea. But I cannot
agree with those who are so sure that it is not capable of revival
there, of improvement, and even of offering a vigorous competition
to Christian evangelizing.
As we climbed up toward the pavilion in which we were to take
our luncheon, we saw few ruins of the structures which were once
scattered over the area within the mountain’s wall; but everywhere
was an abundance of beautiful wild flowers and flowering shrubs.
Among the many varieties were wigelia, cypripedium, several kinds
of iris, Solomon’s-seal, syringa, hydrangea, giant saxifrage, large
white clematis, hawthorne, jassamine, lilies of the valley, many kinds
of violets and azaleas, wild white roses, viburnum, Allegheny vine,
and wild cherry.
About twenty minutes before we reached the pavilion where it was
proposed to spread out our luncheon, great drops of rain caused us
to quicken our pace; and the following smart shower which crept by
the brow of the overhanging mountain, in spite of the protection of
our umbrellas, gave the party somewhat of a wetting before shelter
was reached. But soon the rain was over; the sun came gloriously
out; the mountain stream which was just below the outer wall of the
pavilion ran fuller and more merrily; and the food was more
comforting in contrast with the slight preceding discomfort.
Lying in the sun on a shelving rock, I had an interesting
conversation with the English Consul-General. In the course of this
Mr. Cockburn expressed the amazement of his country at what he
graciously called the “patience” of Americans in putting up so quietly
with political and social wrongs which the English had refused any
longer to suffer, now nearly a century ago. He seemed sincerely
gratified at my assurance that the feeling of the United States
toward England is more cordial and appreciative of our common
good and common mission in the world than was the case twenty-
five and thirty years ago. I found myself also in hearty agreement
with his view that the treaty between Great Britain and Japan,
whether it should prove of commercial advantage to the former, or
not, was fruitful of good to the latter nation, to the Far East, and to
mankind as interested in the world’s peace.
At about four o’clock the party started on its return to Seoul. The
distance was some ten miles, most of which must be walked, by a
rather steep descent in places over barren surfaces of granite rock.
But the path at first led us still higher up the mountain until, having
passed through an inner gate, we reached the outer wall upon the
other side of the whole enclosure. For as much of the slope of Puk
Han, as somewhat more than two miles of rambling wall can
embrace, constitutes this fortified retreat of the Korean monarchy.
Thus, with its stores of provisions and implements of war, the
cultivated fields, palaces, and other official and unofficial residences
inside, it was intended that Puk Han, like its somewhat earlier
colleague, the fortresses of Kang Wha, should resist siege by any
numbers and for any length of time. But from prehistoric times to
Port Arthur, and all over the earth from Sevastopol to Daulatabad,
the experiences of history have shown how vain is the hope of the
rulers of men to ward off the results of moral and political
degeneracy by walls of stone and implements of iron.
Far away on the very top of the mountain, to the left of our path,
stood a watch-tower which commanded a view of all this part of
Korea. From both of the gates in this portion of the wall, which,
although they are only a short distance apart, look toward different
points of the compass, the views are extensive and charming. To the
southward one could look down the steep mountain side, over a
valley from which rose rocky but brilliantly colored hills, bare for the
most part of foliage, and through which the silvery thread of the
River Han wound its way, upon a series of mountain ranges bounded
only by the horizon. From the Western gate were to be seen
Chemulpo and its island-dotted harbor, and beyond the open sea.
The downward path of Puk Han winds around the mountain, from
the Southern gate in the wall toward the northwest; and although it
is quite too steep and rough for safe descent in chairs, it is not
particularly difficult for those who walk it with sound knee-joints and
ordinarily careful and judicious feet. For the first five or six miles it
affords an uninterrupted series of interesting and beautiful views.
Here the colors of the rock, when seen in full sunlight, were trying
for all but the most insensitive eyes. But as the light was modified by
the occasional passing of clouds, or by the changes in the relation of
the path to the points of the compass, the effect was kaleidoscopic
in character on a magnificent scale. On this side of the mountain the
shapes of the rocks are peculiar. In general, each mountain-ridge—
supreme, subordinate, or still inferior—is composed of a series of
pyramidally-shaped granite structures, rising higher and higher as to
their visible summits; but with their sides welded, as it were,
together, and their surfaces of disintegrated yellowish or reddish
rock. Between the sides of the pyramids in each series, and between
the different series, and between the higher ranges composed of the
series, are dry ravines, down which the summer rains descend in
torrents, keeping the slopes of all these rocky elevations almost bare
of verdure. Thus there is produced an aspect of severe grandeur
quite out of proportion to the real height of the mountains. But this
aspect is relieved by an abundant growth of wild flowers and
flowering shrubs—such as have been already named and still others
—with more gorgeous blossoms than I have anywhere else seen
produced by the same species. With these the ladies filled all hands,
and all the luncheon baskets—and then even the chairs, which,
however, we took again as soon as it became practicable, to the
relief of feet and knees; and thus we entered the city by the North-
West Gate, where we stopped awhile to rest the men and to enjoy
the magnificent view of Seoul from the inside of the gate.
The excursion up Puk Han will certainly be remembered by some
of the party as one of the most enjoyable to be obtained anywhere.
It far surpasses most of those much-lauded by the guide-books in
other more frequented but really less rewarding portions of the
world.
If time had permitted, by turning aside an hour or two, the ascent
of Puk Han might have been varied by a visit to the “Great White
Buddha.” This rather interesting relic of a long-time decaying, but
possibly now to be revived, Buddhism, I visited one morning in
company with Mr. Gillett. The path to it leaves the main road some
miles out of the city; where it begins to wind through the paddy
fields it becomes somewhat difficult for jinrikishas. On the way one
passes shrines such as are used not infrequently for the now
forbidden exorcising ceremonies of the sorceresses, and heaps of
stones that are continually being piled upon by the passers along the
way, who wish thus to propitiate the spirits and to obtain good luck.
The Buddha itself is a large and rudely-shaped figure, whitewashed
on to the face of a rock, which has been escarped and covered with
a pavilion, having a highly decorative frieze and a roof set on granite
pillars. A few women were there worshipping in the manner common
to the ignorant populace in Korea and Japan—i. e., clapping the
hands, offering a small coin or two, and mumbling a prayer. A dirty,
disreputable-looking priest was assiduously gathering up the coins,
for they had merely been placed upon a table before the Buddha,
instead of being thrown into an enclosed box. He volunteered the
explanation that this was the most celebrated place in all Korea at
which to offer effective prayer for a son; childless women, and also
men, came from all over the land to worship at this shrine. In Korea,
as well as in India and China, this vulgar and degrading superstition
is connected with ancestor worship—namely, that the welfare of the
living and the dead, in this world and in the next, is somehow
inseparably bound up with begetting and bearing, or somehow
possessing, a male descendant. No heavier curse is put on woman;
no subtler form of temptation to lust for man; no more burdensome
restriction on society; and no more efficient check to a spiritual faith
and a spiritual development exists among the civilized peoples of the
world than this ancient but unworthy superstition. Even devil-
worship is scarcely less cruel and socially degrading.
It was with sincere regret that I left Korea without the opportunity
to see the country even more widely, to feel more profoundly the
spirit of its national life, and to become more acquainted in a
relatively “first-hand” way with its history and its antiquities. I was
confident that I had gained sufficient trustworthy information to
judge fairly of the character of the native government—Emperor and
Court and Yang-bans—to estimate in a measure the difficulties which
encompassed the position of the Resident-General, and to appreciate
the sincerity and self-sacrificing nature of his plans and the value of
his achievements. But there are few countries in the world to-day
where richer rewards await the expert and patient investigator of
history and of antiquities. The history of Korea remains to be
written; its antiquities are there to be explored.
CHAPTER VII
THE DEPARTURE
Soon after breakfast on the morning of the day before our stay in
Seoul came to an end (Monday, May 27th), a telephone message
was reported with the inquiry whether we expected to be at home at
ten o’clock. Contrary to the understanding of the servant who
brought the report, it proved to be Marquis Ito himself who,
accompanied by General Murata, had kindly taken the time from his
always busy morning hours to call in person and bid his guests
good-by. Speaking with his customary quiet deliberation, brevity, and
sincerity, His Excellency thanked me for the services rendered to him
and to his nation, both directly and indirectly, by the visit to Korea;
and the words which added a promise of continued friendship will
always remain among the choicest of memories. In reply—with more
adequate reason but with no less sincerity and earnestness—I
thanked the Marquis for the confidence he had reposed in me, and
as well for the experience which his invitation had furnished. If I had
been of some small service, I had received a much more than
adequate reward in the opportunity of seeing an interesting side of
human life which had hitherto been, for the most part, unfamiliar to
me. I also expressed my belief in a universal and omnipotent Spirit
of Righteousness, who shapes the destinies of men and of nations,
and who uses us all in His service—if we so will—to our own real
well-being and to the good of humanity. God has so bound together
Japan and Korea, both physically and politically, that their interests
cannot be separated, whether for weal or for woe.
In the afternoon of the same day, at the house of Mr. D. W.
Stevens, whose hospitality we had before enjoyed and whose
friendship we had learned highly to prize, we met at tea some
twenty-five of the most intimate of the acquaintances made during
the previous two months. This was not, however, our final leave-
taking of these friends. For the next morning at 8.50, at the South-
Gate Station, most of the same persons gathered to give us one of
those partings which one would not gladly miss, but which are
always a mixture of sad pleasure and sweet pain. The insight of the
Japanese language into such human experiences is shown by the
fact that it has a single word which combines all these complex
elements, and expresses them in itself. Nor do I find that the
repetition of many such experiences in different far-away lands at all
changes the intrinsic character of the feelings they excite. To make
friends away from home is the traveller’s choicest pleasure; to part
soon from these friends is the traveller’s keenest pain.
The journey from Seoul to Fusan was without incident and
accomplished on time. As furnishing a change in the character of the
surroundings, it is almost equivalent to going from Korea to Japan.
For Fusan is essentially a Japanese city, and has been such for many
years. The greeting given us on arrival was also characteristically
Japanese. There, on the platform, were thirty or more of both sexes,
including the Resident and other officials, whose cards were handed
to us with such speed and profusion that to recognize names was
impossible, and even to avoid dropping some of the pieces was
difficult. The harbor launch again served us, as it had done before,
for transportation between railroad station and Japanese settlement.
Only twenty minutes were allowed for effecting a presentable
appearance after the day’s travel; and then we were ushered to the
dining-room, where about fifty persons had gathered for a
complimentary banquet. After this, the Resident introduced,
welcomed, and proposed a toast for the guests, and Mr. Zumoto
interpreted the response. The banquet finished, there followed, in
another part of the hotel, an entertainment of juggling, a farce, and
dancing to samisen and koto—all by amateur performers. The day
had certainly, when it ended, been sufficiently full of incident. But a
real old-fashioned Japanese bath, in a deliciously soft wooden tub,
with water at 108° Fahrenheit—the first I had been able to obtain
during this visit to Japan—took away all soreness of flesh and
weariness of spirit, and secured a good night’s rest.
The following morning in Fusan was dull and unpromising—there
was drizzle, cloud, and fog over land and sea, and a fresh breeze. In
spite of the weather, however, we were taken in jinrikishas to the
villa of Mr. Kuruda, one of the oldest of the Japanese settlers, a
prosperous commission merchant and manufacturer of saké. This
villa is seated on the mountain’s side and is surrounded by as fine an
example of a certain style of Japanese gardening as I have ever
seen. Here is a profusion of artistic rock arrangement, decorated
with shrubs and flowers, for the most part brought from Japan, and
marking out ponds, paths, and favored points of view from which
can be had glimpses of the charming harbor and surrounding hills.
The owner was proud to have us know that Marquis Ito makes the
villa his home when journeying between Korea and Japan. Among
other objects of interest in the garden is a huge boulder which fell
from the mountain’s side some twenty years ago; near this the
owner of the garden has chosen his last resting-place, and upon it
the proper inscription has already been prepared.
After leaving the villa we were shown over one of the public
schools which has been founded for the children of Japanese
residents, and were bidden to notice how its reports showed the
high average attendance of from 93 per cent. to 98 per cent., and
even above, in the different grades, for the entire year. Next came a
visit to a private school for girls, which is under the patronage of
Japanese ladies, and which gives an education of a more distinctly
domestic type. Here we were served with an excellent luncheon in
foreign style, cooked by the pupils of the school; during and after
which there was an entertainment consisting of tableaux vivants and
a musical performance that might best be described as a trio of
kotos with a violin obligato. One of these tableaux represented three
young girls defending a castle wall with bow and arrow—a scene
corresponding to actual events of history; for, in fact, the loyalty of
certain clans in the north of Japan carried them to such extremes in
support of the Tokugawa dynasty. Indeed, through many centuries,
Japanese women and girls have been far braver and more loyal in
defence of their liege lord than Korean men have been.
From this school we were taken to the park on the mountain, with
its trees brought from Tsushima some two hundred years ago, to
which reference has already been made (p. 15) as the only one in all
Korea. The Shinto temple upon the hill-top is equally old, and was
originally dedicated to no fewer than nine different divinities—the
goddess, Amaterasu (the “Heaven-Shiner,” or Sun-goddess), born
from the left eye of the Creator Izanagi, whose principal shrine is
now at Ise, being the chief.
The lecture of the afternoon was given to an audience of about six
hundred, upon a topic selected by those who had extended the
invitation. This topic was “The Necessity of an Improved Commercial
Morality”; it was expected that the speaker would enforce and
illustrate the thought by the situation at the present time in Korea,
and by an appeal to Japanese patriotism to show their nation worthy
of setting a good example, and capable of accomplishing the task of
industrial development and political redemption in the land which
was now so dependent upon Japan for its future. Mrs. Ladd also said
a few words expressing her interest in what we had seen in the
morning illustrating the education given to Japanese girls in Fusan,
and also the hope that something similar might soon be possible for
their Korean sisters. The heartiness with which these suggestions
were received in this, the principal Japanese settlement of the
Peninsula, shows that the better classes of settlers are honorably
sensitive to the obligation to redeem the fair fame of their nation
from the injury which it has received in the past at the hands of the
inferior and baser elements of their own countrymen.
That this determination was not beyond reasonable hope of
speedy realization was made more evident to me by conversation
with the agent of the Transportation Company operating between
Shimonoseki and Fusan. A careful investigation of its records had
revealed the fact that for some months past about 200 Japanese
passengers were, on the average, daily coming into Korea, and only
about 150 returning from Korea to Japan. Of the fifty who,
presumably, remained as settlers, about one-half chose for their
home either the city of Fusan or the surrounding country; the other
half went by rail inland, chiefly to Seoul and Chemulpo. There had
also been of late an obvious change in the character and intention of
these immigrants. Formerly, they were largely young fellows of the
type of adventurers; but now the old people, and the women and
children, were coming with the men—an indication that their
business was no temporary venture, but a purpose to remain and
make homes for themselves. When it is understood that these
figures are exclusive of the Japanese military and civil officials, they
compare very closely with the results of the census taken just before
our departure. On taking passage from Shimonoseki to Fusan we
had noticed that the passengers which crowded and overflowed the
second- and third-class cabin accommodations of the steamer
appeared to be very decent folk. Many of them had brought along,
not only their luggage, but also their agricultural implements and
mechanic’s tools. But the subject of Japanese settlement in Korea,
and its effect upon both countries concerned, is so important as to
deserve further discussion of such statistics as are now available.
We went on board the Iki Maru early enough to avoid the crowd
that would come by the afternoon train from Seoul. After bidding
good-by to the score of ladies and gentlemen who had come down
to the wharf to see us off, there was time for dinner before the
steamer sailed. As we watched the retreating shores of Korea, we
remembered the morning of two months before when these shores
had first come into view. It was Japanese friends who had then
welcomed us—the same friends who had just bidden us farewell. But
between the two experiences lay a busy period of work and of
observation which had resulted in making more friends, Japanese
and foreign, in Korea itself. But how about the Koreans themselves;
had we won, even to the beginnings of real and constant friendly
feeling, any among their number? I was unable confidently to say.
The Koreans are spoken of, by the missionaries especially, as notably
kind and affectionate in disposition and easily attached to the
foreigner by friendly ties. By the diplomats and business men they
are, for the most part, distrusted and despised. As the guests of
Marquis Ito, it was not strange that we did not quickly gain any
assurance of genuine and trustworthy friendliness on their part. But
this, too, is a subject which requires consideration from a more
impersonal point of view. For there is something startling in the wide
divergencies, and even sharp antagonisms, of the estimates of
Korean character which any serious and disinterested inquiry evokes.
The night of May 29th was rough, and our ship rolled considerably
while crossing the straits between Korea and Japan. But by early
morning we were in smooth water. The likenesses and the contrasts
of the two countries were even more impressive than they had been
when we first landed in Fusan and passed on to Seoul. Soil and
landscape, as unmodified by man, are in this part of Japan almost
exactly similar to southern Korea. Indeed, geologically speaking,
they are the same continent; at one time in the past they were
doubtless physically united. But how different the two countries at
the present time, in respect of all the signs of human activity and
human enterprise! Our Japanese companion explained the prosperity
of this part of his native land as growing out of the nature of its
early history. Prince Mori was formerly lord of all this part of Japan,
nearly as far eastward as Hiogo. When driven by Hideyoshi to its
western extremity, he had taken with him a large number of his best
retainers. Their support in the two or three districts which he was
still allowed to retain became at once a most difficult practical
problem. But it was solved by stimulating the farmers and the
trading classes to the highest possible activity in improving the
natural resources, which were by no means unusually great in this
part of Japan. Thus it was the men who made the country rich, and
not the country that made the men rich. One other illustration of the
characteristically different spirit of the two countries was mentioned
in the same connection. At one time when Hideyoshi was making
war upon Prince Mori, he was called back by a rebellion in his own
rear. One of his most devoted friends and adherents had been
murdered by the rebels. Whereupon, Hideyoshi summoned his
enemy, told him frankly the truth as to the necessity of his
abandoning for the present his intention to deprive him of all his
dominions, and suggested that the time would be opportune for the
Prince to recover much of his lost ancestral estate. But Prince Mori
declined to take advantage of Hideyoshi’s necessity, since the latter
was going, as in knightly-honor bound, to avenge the death of a
friend.
On coming to anchor in the harbor of Shimonoseki we found the
superintendent of the port ready with his launch to convey us to the
shore. After an hour at the hotel, during which the chief of police
made an official call to pay his respects and give us additional
assurance that we were to be well protected, we parted at the train,
with sincere regret, from the Japanese friend who had so kindly
arranged all for our comfort during our two months in Korea.
The appearance of the country along the western end of the
Sanyo Railway on this last day of May, 1907, fully confirmed the
account of the character and the policy of the men who, since the
time of Hideyoshi, have developed it. The views of the sea on the
right-hand side of the train cannot easily be surpassed anywhere in
the world. On the other side, the fields in the valleys, and the
terraces on the hills, constitute one almost continuous, highly
cultivated garden for more than one hundred miles. The tops of the
mountains, except in a few unfavorable spots, are covered with
forests of thickly-set and varied arborage. The comparatively damp
climate of Japan covers with that exquisite soft haze which the
Japanese artists appreciate so highly and reproduce so well, the
same kind of soil and of rocks which shine out so bright and strong
in their coloring across the straits in Korea.
In the train, my next neighbor on my right—a big German who
smoked strong cigars incessantly, and who said that he had been in
the Orient for forty years—declared unhesitatingly that the people of
Japan, outside of a certain portion of a few cities where foreign
influences had operated most strongly, were all savages to-day, as
they were when the country was first opened to Western civilization.
When he was reminded that the percentage of children in actual
attendance in the public schools was much larger than in the United
States, and at least equal to the most favored parts of Germany, he
replied that the children were never really being taught in school,
but always to be seen out of doors, going through some kind of
“fanatics” or gymnastics! It is no wonder that this comment elicited
no reply. But the picture of the more than a score of thousands of
eager and attentive teachers and students to whom I had spoken—
not by way of occasional, popular speeches, but in courses of
lectures and addresses on serious themes—left me unconvinced. Nor
was the remark attributed to the inferior insight of his own nation,
whose scholastic training for diplomatic service has been superior to
that of other countries, and whose commercial education is fast
approaching the same grade of excellence. But it was another lesson
in the purely external and untrustworthy character of the prevailing
knowledge of the Far East, its people, their excellences and their
faults; and, per contra, of the only way reasonably to estimate and
effectually to attain friendly relations with men in general and with
Oriental peoples in particular. The views of the “old resident”—
missionary, diplomat, or business man—as such, are of little or no
value. This is especially true as touching the relations of Japan and
Korea.
CHAPTER VIII
PERSONAL REMINISCENCES AND IMPRESSIONS
Before leaving Seoul I ventured to send to His Imperial Majesty of

Korea, through one of his most intimate, devoted, and consistent
friends of long standing, a message that should embody some of my
impressions regarding his own best interests and the essential
conditions for the future welfare of his country. I had already
frequently addressed his people with great plainness, relying upon
an implied confidence in the sincerity of their monarch’s words,
spoken at the time of my audience at the Court. It will be
remembered (see p. 46) that the Emperor had then said: “He was
glad to learn I had come to instruct his people in right ways”; “he
hoped they would open their minds to enlightenment and to modern
ideas”; he wished “my addresses would contribute to their progress.”
The speaker had, therefore, not only royal permission but that
request, which, according to the etiquette of this and other Eastern
courts, is the equivalent of a command, when he warned his Korean
audiences that the real prosperity of their country could not be
obtained by intrigue and assassination, but only by cultivating the
industries and arts, by improving education, and by regulating their
conduct according to the unchanging principles of a pure morality
and a truly spiritual religion. Moreover, it should be remembered
that, while Oriental monarchs are accustomed to think of themselves
as entitled to rule without regard to constitutional restrictions and in
defiance of control by any legal code, the Confucian ethics requires
them to submit patiently to rebuke and exhortation, on moral
grounds. It also exalts the position of the teacher of practical
philosophy (or ethics) to the highest rank in the service of the State.
Nor had I forgotten the earnest words of the aged Japanese
physician at a banquet held on the evening of the preceding 11th of
February, in the city of Osaka, by which the one hundred and fifty
leading citizens assembled there were reminded that, when the
ancient Oriental teacher and the modern teacher from the West
agree in the doctrine—“It is righteousness which exalteth a nation”—
their agreement is significant of the important conclusion that the
doctrine is true. It did not seem improper, therefore, to call his
Majesty’s attention to the rocks just ahead, directly for which, under
the piloting of evil domestic and foreign counsellors, he was steering
the ship of State.
The message emphasized especially the following particulars.
Inasmuch as Japan had already fought one internal and two foreign
wars, at a cost of millions of treasure and thousands of lives, on
account of the political weakness and misrule of Korea, it could not
possibly, with a wise regard either for its own interests or for those
of the Korean people themselves, allow the repetition of similarly
disastrous events. The two nations must learn to live together in
amity and with their common interests guarded against invasion and
injury from without. History had amply shown that this end could not
be secured under existing conditions by Korea alone. The most
sacred obligations, not only of self-interest, but also of a truly wise
regard for the Emperor and his subjects, bound the Japanese
Government to establish and maintain its protectorate over Korea.
Further: no foreign nation, least of all my own, whose constitution
and traditional practice forbade such a thing, was at all likely to
intervene between Japan and Korea. Those counsellors who had led
him to hope for such intervention were deceiving him; and the
money which he had contributed to their schemes was not simply
spent in vain; it was beguiled from him to his own hurt and to the
great injury of his own people, who needed that every yen of it
should be judiciously expended upon developing the resources of
the country and improving their own material condition.
From these points of view, which had regard chiefly, or even
solely, to the interests of the crown and the Korean nation, I
regarded the Resident-General as Korea’s best friend; and also—if
the Emperor would have it so—his own best friend. Of Marquis Ito’s
sincere and intelligent interest in Korea, no one who knew him could
have the slightest doubt; the Emperor must see that the Marquis, as

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UNIT THREE 155

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16. Musculoskeletal Problems 407

UNIT FOUR 495

UNIT FIVE 527

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APRN REGULATORY MODEL

Family/Individual Women’s Health/ Psychiatric-

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• Dimension 1—Clinical Management

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Designing Your Study Plan

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This chapter has several parts. The first part actively

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Shortly after the inauguration of the Residency-General last

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Among the several attempts at photographing made on the way to

Before leaving Seoul I ventured to send to His Imperial Majesty of

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