QUIZ BEE QUESTIONS – DIFFICULT ROUND

NEUROSENSORY DISORDERS

 For a client with suspected increased intracranial pressure (ICP), a most appropriate respiratory
goal is to:

a. prevent respiratory alkalosis.

b. lower arterial pH.

c. promote carbon dioxide elimination.

d. maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg.

Correct Answer: c

RATIONALE: The goal of treatment is to prevent acidemia by eliminating carbon dioxide. That is because
an acid environment in the brain causes cerebral vessels to dilate and therefore increases ICP. Preventing
respiratory alkalosis and lowering arterial pH may bring about acidosis, an undesirable condition in this
case. It isn't necessary to maintain a PaO2 as high as 80 mm Hg, 60 mm Hg will adequately oxygenate
most clients.

 The nurse observes that decerebrate posturing is a comatose client's response to painful stimuli.
The client exhibits extended and pronated arms, flexed wrists with palms facing backward, and
rigid legs extended with plantar flexion. Decerebrate posturing as a response to pain indicates
which of the following?

a. Dysfunction in the cerebrum

b. Risk for increased intracranial pressure

c. Dysfunction in the brain stem

d. Dysfunction in the spinal column

Correct Answer: c

RATIONALE: Decerebrate posturing indicates damage of the upper brain stem. Decorticate posturing
indicates cerebral dysfunction. Increased intracranial pressure is a cause of decortication and
decerebration. Alterations in sensation or paralysis indicate dysfunction in the spinal column.
 QUIZ BEE QUESTIONS – DIFFICULT ROUND

PSYCHIATRIC NURSING

 A client who lost her home and dog in an earthquake tells the admitting nurse at the community
health center that she finds it harder and harder to "feel anything." She says she can't concentrate
on the simplest tasks, fears losing control, and thinks about the earthquake incessantly. She
becomes extremely anxious whenever the earthquake is mentioned and must leave the room if
people talk about it. The nurse suspects that she has:

a. phobic disorder.
b. conversion disorder.
c. posttraumatic stress disorder (PTSD).
d. adjustment disorder.

Correct Answer: c

RATIONALE: PTSD may occur in survivors of earthquakes and other events outside the range of usual
human experience. Typically, the victim repeatedly relives the event mentally and exhibits numbed
emotional responsiveness and difficulty concentrating. PTSD also may cause an inability to function in daily
life, memory impairment, chronic anxiety, insomnia, and hyper alertness. In a phobic disorder, the client
fears an object or situation that doesn't present any real danger. Conversion disorder typically causes
changes or losses in physical function that suggest a physical disorder but actually are expressions of a
psychological conflict. In adjustment disorder, the stressor usually is less severe than in PTSD and is within
the range of usual experience.

 Most antipsychotic medications exert which of following effects on the central nervous system
(CNS)?
a. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin
receptors.
 QUIZ BEE QUESTIONS – DIFFICULT ROUND

b. Sedate the CNS by stimulating serotonin at the synaptic cleft.

c. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and
norepinephrine
d. Depress the CNS by stimulating the release of acetylcholine.
Correct Answer: c
RATIONALE: The exact mechanism of antipsychotic medication action is unknown, but these drugs appear
to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and
norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate
neurotransmitter action or acetylcholine release.

GASTROINTESTINAL DISORDERS
 When preparing a client, age 50, for surgery to treat appendicitis, the nurse formulates a nursing
diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the
rationale for choosing this nursing diagnosis?
a. Obstruction of the appendix may increase venous drainage and cause the appendix to
rupture.
b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and
rupture of the appendix.
c. The appendix may develop gangrene and rupture, especially in a middle-aged client.
d. Infection of the appendix diminishes ne crotic arterial blood flow and increases venous
drainage.
Correct Answer: b
RATIONALE: A client with appendicitis is at risk for infection related to inflammation, perforation, and
surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the
appendix and compressing venous outflow drainage. The pressure continues to rise with venous
obstruction, arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation
and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in
gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.

 A client with severe inflammatory bowel disease is receiving total parenteral nutrition (TPN). When
administering TPN, the nurse must take care to maintain the prescribed flow rate because giving
TPN too rapidly may cause:
 QUIZ BEE QUESTIONS – DIFFICULT ROUND

a. hyperglycemia.
b. air embolism.
c. constipation
d. dumping syndrome.
Correct Answer: a
RATIONALE: Hyperglycemia may occur if TPN is administered too rapidly, exceeding the client's glucose
metabolism rate. With hyperglycemia, the renal threshold for glucose reabsorption is exceeded and osmotic
diuresis occurs, leading to dehydration and electrolyte depletion. Although air embolism may occur during
TPN administration, this problem results from faulty catheter insertion, not overly rapid administration. TPN
may cause diarrhea, not constipation, especially if administered too rapidly. Dumping syndrome results
from food moving through the GI tract too quickly, because TPN is given I.V., it can't cause dumping
syndrome.

RESPIRATORY DISORDERS
 A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55;
partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide
(PaCO2). 27 mm Hg; and bicarbonate (HCO-), 24 mEq/L. Based on these values, the nurse
suspects:
a. metabolic acidosis.
b. metabolic alkalosis.
c. respiratory acidosis.
d. respiratory alkalosis.
Correct Answer: d
RATIONALE: This client's above-normal pH value indicates alkalosis. The below-normal PaCO2 value
indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis. These
ABG values wouldn't occur in metabolic acidosis, respiratory acidosis, or metabolic alkalosis

 A client with pneumonia is admitted to an acute care facility and is receiving supplemental oxygen,
2 L/min via nasal cannula. The client's history includes chronic obstructive pulmonary disease
(COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors
the oxygen flow and the client's respiratory status. Which complication may arise if the client
receives a high oxygen concentration?
a. Apnea
b. Anginal pain
 QUIZ BEE QUESTIONS – DIFFICULT ROUND

c. Respiratory alkalosis
d. Metabolic acidosis
Correct Answer: a
RATIONALE: Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen
administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced
myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction
secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing
anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen
administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to
respiratory acidosis, not alkalosis. High oxygen concentrations don't cause metabolic acidosis

MUSCULOSKELETAL DISORDES
 After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?
a. Monitoring the client for skin breakdown
b. Maintaining traction continuously to ensure its effectiveness
c. Supporting the traction weights with a chair or table to prevent accidental slippage
d. Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use
Correct Answer: b
RATIONALE: The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse
should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights
must hang freely to be effective; they should never be supported. The nurse should increase, not restrict,
the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation
associated with complete bed rest.

 The nurse is caring for a client who underwent a total hip replacement. What should the nurse and
other caregivers do to prevent dislocation of the new prosthesis?
a. Keep the affected leg in a position of adduction.
b. Use measures other than turning to prevent pressure ulcers.
c. Prevent internal rotation of the affected leg.
d. Keep the hip flexed by placing pillows under the client's knee.
Correct Answer: c
 QUIZ BEE QUESTIONS – DIFFICULT ROUND

RATIONALE: External rotation and abduction of the hip will help prevent dislocation of a new hip joint.
Internal rotation and adduction should be avoided. Postoperative total hip replacement clients may be
turned onto the unaffected side. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and
maintenance of flexion isn't necessary.