Kaplan NCLEX Question of The Day

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A client returns to the nursing unit post-thoracotomy with two chest tubes in place connected to a drainage device. The client's spouse asks the nurse about the reason for having two chest tubes. The nurse's response is based on the knowledge that the upper chest tube is placed to:

  • A. Remove air from the pleural space
  • B. Create access for irrigating the chest cavity
  • C. Evacuate secretions from the bronchioles and alveoli
  • D. Drain blood and fluid from the pleural space
Correct Answer: A

Rationale: The correct answer is 'Remove air from the pleural space.' When a client has two chest tubes in place post-thoracotomy, the upper chest tube is typically positioned to remove air from the pleural space. Air rises, so placing the tube at the top allows for efficient removal of air that has accumulated in the pleural cavity. Choice B, creating access for irrigating the chest cavity, is incorrect as chest tubes are not primarily used for irrigation. Choice C, evacuating secretions from the bronchioles and alveoli, is incorrect as chest tubes are not designed for this purpose. Choice D, draining blood and fluid from the pleural space, is also incorrect as the upper chest tube in this scenario is specifically for removing air, not blood or fluid.

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What vitamin is important in preventing peripheral neuritis in a client with alcohol abuse?

  • A. Vitamin D
  • B. Fat-soluble vitamins
  • C. B vitamins
  • D. Potassium
Correct Answer: B

Rationale: The correct answer is 'Fat-soluble vitamins.' Vitamin B, not Vitamin D, is crucial in preventing peripheral neuritis in individuals with alcohol abuse. Vitamin B deficiency, particularly B1 (thiamine), is commonly associated with peripheral neuritis in alcoholics. Therefore, choices A, C, and D are incorrect. Vitamin D is not directly related to peripheral neuritis, and potassium deficiency typically presents with different symptoms.

The client has been taking divalproex (Depakote) for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test?

  • A. Alanine aminotransferase (ALT)
  • B. Serum glucose
  • C. Serum creatinine
  • D. Serum electrolytes
Correct Answer: A

Rationale: The correct answer is Alanine aminotransferase (ALT). Monitoring ALT levels is crucial when a patient is taking divalproex (Depakote) due to the risk of drug-induced hepatitis. Elevated ALT levels indicate liver damage or disorders, which can be a side effect of Depakote. Serum glucose (choice B) is not the priority for monitoring in this case, as the medication does not directly affect glucose levels. Serum creatinine (choice C) is not the most relevant test to monitor for Depakote use; it primarily assesses kidney function. Serum electrolytes (choice D) are important but do not take precedence over monitoring ALT levels when a patient is on Depakote.

What is the most common cause of acute renal failure?

  • A. Shock
  • B. Nephrotoxic drugs
  • C. Enlarged prostate
  • D. Diabetes
Correct Answer: A

Rationale: The correct answer is 'Shock.' Acute renal failure is commonly caused by inadequate blood flow to the kidneys, which can occur in cases of shock. This leads to decreased kidney function and potential kidney damage. While nephrotoxic drugs can also cause acute renal failure, shock is the primary and most common cause. An enlarged prostate may lead to obstructive uropathy but is not the most prevalent cause of acute renal failure. Diabetes is typically associated with chronic kidney disease rather than acute renal failure.

After a client with an Automated Internal Cardiac Defibrillator (AICD) is successfully defibrillated for Ventricular Fibrillation (VF), what should the nurse do next?

  • A. Go to the client to assess for signs and symptoms of decreased cardiac output.
  • B. Call the physician to inform them of the VF episode for medication adjustments.
  • C. Call the 'on-call' person in the cath lab to re-charge the ICD in case of a recurrence.
  • D. Document the incident on the code report form and follow up regularly.
Correct Answer: A

Rationale: After a client is successfully defibrillated, the immediate priority is to assess the client for signs and symptoms of decreased cardiac output, such as altered level of consciousness, chest pain, shortness of breath, or hypotension. This assessment is crucial to determine the effectiveness of the defibrillation and the client's current hemodynamic status. Calling the physician for medication adjustments without assessing the client first could delay essential interventions. Contacting the 'on-call' person in the cath lab to re-charge the ICD is not the initial action needed after successful defibrillation. Documenting the incident is important but should not take precedence over assessing the client's immediate condition.

A client has been receiving cyanocobalamin (B12) injections for the past 6 weeks. Which laboratory finding indicates that the medication is having the desired effect?

  • A. Neutrophil count of 60%
  • B. Basophil count of 0.5%
  • C. Monocyte count of 2%
  • D. Reticulocyte count of 1%
Correct Answer: D

Rationale: Cyanocobalamin is a B12 medication used for pernicious anemia. A reticulocyte count of 1% indicates the desired effect of the medication, as reticulocytes are immature red blood cells that increase in response to B12 therapy, improving anemia. Neutrophils, basophils, and monocytes are white blood cells and are not directly influenced by B12 injections, making them incorrect choices.

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