Deck 23: Thoracic Surgery

Question 1

As the perioperative nurse gathers information that is important to planning patient care,he or she should inquire about a patient's tobacco use (including the use of cigars,pipes,tobacco,or controlled substances)and any exposure to secondhand smoke within the home and/or workplace and reinforce the need to abstain following surgery.Patients might be sensitive about smoking history because of the assumed relationship between smoking and lung disease.Select the best approach the nurse could use in assessing a patient's smoking history.

A) The nurse should begin preparing the patient for nicotine withdrawal.
B) The nurse should avoid making assumptions about smoking and a cancer diagnosis.
C) The nurse should note packs/day consumption to alert the surgeon to write postoperative orders for medication.
D) The nurse should phrase questions so as not to suggest judgment about smoking behaviors.

Answer 1

D
The nurse should phrase questions in a way that will not result in guilt about smoking habits or assumptions that the diagnosed condition is associated with smoking,phrasing questions in a nonjudgmental manner to respect any feelings the patient may have.

Question 2

Lung volume reduction surgery (LVRS)is an alternative surgical treatment for patients with which pulmonary condition?

A) Chronic pulmonary asthma with oxygen needed to keep saturation at 90%
B) Acute unilateral pulmonary emphysema
C) Chronic pulmonary emphysema
D) Unsuccessful or failed laser surgery for giant lung bulla

Answer 2

C
Lung volume reduction surgery (LVRS)is an alternative surgical treatment for patients with chronic pulmonary emphysema.The surgery is intended to increase expiratory airflow,maximal exercise capacity,and respiratory muscle strength,thereby relieving dyspnea.The procedure may also be referred to as lung volume reduction,or pneumoplasty.Candidates for the procedure are those who have progressive,severe dyspnea secondary to pulmonary dysfunction; those whose medical management is ineffective; and those in whom disease distribution is limited to target areas of severity.

Question 3

Direct visualization of the mucosa of the trachea,the main bronchi and their openings,and most of the segmental bronchi may also include the removal of material for microscopic study and is an integral part of the examination of patients with pulmonary symptoms such as persistent cough or wheezing,hemoptysis,obstruction,and abnormal roentgenographic changes.What diagnostic modality has been described?

A) Standard bronchoscopy
B) Flexible panendoscopy
C) Rigid pulmonary investigation
D) Video bronchogram

Answer 3

A
Standard bronchoscopy is the direct visualization of the mucosa of the trachea,the main bronchi and their openings,and most of the segmental bronchi.It also includes removal of material for microscopic study if necessary.Bronchoscopy is an integral part of the examination of patients with pulmonary symptoms such as persistent cough or wheezing,hemoptysis,obstruction,and abnormal roentgenographic changes.

Question 4

A 46-year-old man with early-stage lung cancer was listening to his surgeon describe the surgical plan in preparation for signing the informed consent.The surgeon described a procedure that would be done before the thoracoscopic lung surgery.The surgeon described an examination of the middle chest lymph nodes and the area below where the bronchi branch into the right and left lungs,and possibly taking biopsies of suspicious tissue.The procedure uses a hollow lighted tube with fiberoptic light-carrying fibers.Which diagnostic procedure will precede the patient's thoracoscopic lung surgery?

A) Esophagoscopy
B) Mediastinoscopy
C) Bronchoscopy
D) Panendoscopy

Question 5

Patients with lung cancer may have specific treatment based on their tumor,node,and metastasis (TNM)characteristics.An example of a true statement about the TNM system is:

A) the cancer staging system is based on the TNM findings.
B) the TNM system is based on the staging classification.
C) nodal involvement refers to a second primary lung cancer tumor.
D) a patient with T₁, N0, M0 has a benign tumor.

Question 6

A 52-year-old school teacher diagnosed with early stage nonsmall cell lung cancer is scheduled for a lung resection.She is selected for the ambulatory surgery center's fast track recovery and discharge program.Which of the following statements describes a component of an ERAS care approach for thoracic surgery?

A) Cessation of smoking and participation in a preoperative exercise program is required.
B) Postoperatively, chest tube management is streamlined by placing the tube to water seal after a brief period of suction.
C) Patients will not be discharged to home with the chest tube in place.
D) Early ambulation is critical and patients walk a short distance within the first hour after extubation.
E) Fluid administration is kept to a minimum to minimize the risk of pulmonary edema and acute lung injury.

Question 7

The nerves of the lungs are a part of the autonomic nervous system.Which structures are constricted and relaxed by their influence?

A) The bronchi and the blood vessels
B) The alveoli and the pulmonary vein
C) The pulmonary artery and vein
D) The bronchi and bronchioles

Question 8

Inspiration normally takes place when the intrathoracic pressure is slightly below atmospheric pressure and when a partial vacuum exists between the parietal and visceral pleural (intrathoracic)surfaces.As the muscles of inspiration contract to enlarge the chest cage,which action by the lungs occurs to facilitate air intake?

A) The lungs recoil and expand to draw air into them.
B) The lungs are passive and follow the diaphragm and chest wall.
C) The lungs produce a pressure gradient that suctions air.
D) The alveolar sacs expand when triggered by neural triggers in all 10 lung segments.

Question 9

A patient's mediastinal node biopsies were sent for immediate frozen section and revealed metastasis of the primary tumor of the left upper lobe to the ipsilateral mediastinal nodes.The patient's TNM and staging classification is:

A) Stage II due to the TNM subset of T₁, N₁, M0.
B) Stage I due to the TNM subset of T₁, N0, M0.
C) Stage IV due to the TNM subset of T₄, N₂, M₁.
D) Stage IA due to the TNM subset of T₁, N₁, M₁.

Question 10

Pleurodesis is undertaken as a treatment for malignant pleural effusion and for unresolved spontaneous pneumothorax.The end point goal of a pleurodesis is to:

A) prevent accumulation of pleuritic secretions.
B) bond the parietal pleura to the lung.
C) achieve permanent pneumothorax.
D) cause adherence of the pleural layers.

Question 11

Of all the equipment,tools,and studies available during the patient's preoperative diagnostic phase,which exam is the most indispensable diagnostic tool to outline thoracic lesions and define space-occupying nature and shape?

A) Virtual bronchoscopy
B) Ultrasound
C) Chest X-ray
D) Computed tomography (CT) scan

Question 12

Video-assisted thoracic surgery (VATS)is a minimally invasive operative technique that has evolved over the past decade.It uses an endoscopic approach to visualize the thoracic cavity for diagnosis of pleural disease or treatment of pleural and lung conditions.In the adult,the surgeon creates a 2- to 3-cm incision between the ________ intercostal spaces for insertion of the 10- or 12-mm trocar.The trocar sites can also be used for insertion of a ____________.

A) fourth and sixth; robotic grasper
B) sixth and eighth; chest tube
C) fifth and seventh; zero-degree scope
D) sixth and eighth; video camera

Question 13

A 59-year-old retired roofer with mesothelioma is scheduled for a left pleurodesis for malignant pleural effusion and unresolved spontaneous pneumothorax.The perioperative nurse responsible for the thoracic surgery service has consulted with the surgeon and determined that talc will be used.What are the nursing implications related to the use of talc?

A) Talc requires special handling and nurses should follow hospital policies and procedures.
B) Adverse reactions to talc include pain, neutropenia, and potential toxicity from systemic absorption.
C) Talc may be administered as a poudrage, aerosol, or slurry.
D) Patients must be assessed for talc allergy.

Question 14

What is the ideal position for bronchoscopy?

A) Supine
B) Left semilateral
C) Supine with a shoulder roll
D) Semi-Fowler with neck extended

Question 15

Thoracotomy can be performed with the patient in one of three common positions.Which of these positions is used for an anterolateral approach?

A) Semilateral
B) Lateral
C) Prone
D) Supine

Question 16

During an endoscopic thoracic sympathectomy for hyperhidrosis,what action by the anesthesia provider ensures exposure and minimizes damage to the lung?

A) Positions the patient in the anterolateral position with an expandable axillary roll.
B) Decreases ventilatory pressure to decrease lung expansion during dissection.
C) Deflates the lung on recommendation of the surgeon during dissection and resection.
D) Decreases positive end-expiratory pressure (PEEP) until resection is complete.

Question 17

After reviewing the laboratory results and assessing the patient,the perioperative nurse determines that the patient's nursing diagnosis is impaired gas exchange related to surgical intervention.Select the appropriate nursing intervention that is related to assisting the patient to experience adequate gas exchange during the surgical procedure.

A) Decrease surgical time by anticipating needs of the patient and surgical team.
B) Collaborate in positioning the patient to provide access to the endotracheal tube, enable efficient ventilatory function, and prevent injury.
C) Obtain chest X-ray films for the intraoperative period.
D) Consult with the surgeon, requesting an order to repeat the laboratory test.

Question 18

During electromagnetic navigation bronchoscopy (ENB),the surgeon uses electromagnetic sensors to:

A) prevent perioperative respiratory distress.
B) identify the position of the lesion.
C) monitor respiratory status.
D) increase respiratory airflow.

Question 19

The great vessels of the head,neck,and arm pass through a junction bound anteriorly by the manubrium,anterolaterally by the first ribs,and posteriorly by the first thoracic vertebrae and posterior angles of the first ribs of the space.Which syndrome is caused by the compression of these structures?

A) Brachial plexus palsy
B) Vertebral spondylolisthesis
C) Thoracic outlet syndrome
D) Thoracic plexus compression

Question 20

The indications for single-lung transplantation (SLT)include restrictive lung disease,emphysema,pulmonary hypertension,and other nonseptic end-stage pulmonary diseases,while the indications for double-lung transplantation (DLT)includes patients with:

A) bilateral early-stage sarcoma without systemic disease.
B) bilateral chronic infection causing end-stage renal failure.
C) cystic fibrosis in end-stage pulmonary failure.
D) bilateral disease, recent ex-smoker with a suitable living-related donor.

Question 21

In the last decade,many energy devices have entered day-to-day practice in thoracic surgery.These energy devices include:

A) ultrasonic shears.
B) Sanders Venturi system.
C) stereotactic ablative radiotherapy.
D) argon plasma coagulation.
E) radiofrequency ablation.

Question 22

Patients having thoracic surgery share a common nursing diagnosis of risk for impaired skin integrity related to surgical positioning,length of surgical intervention,or use of chemical antimicrobial agents on the skin.The type of position used in thoracic surgery is determined by the operative procedure planned.In addition to placing the patient in appropriate body alignment,what other interventions can ensure that the patient's skin integrity is maintained?

A) Ensure adequate padding and safe transfer.
B) Check pulses and skin condition immediately after positioning.
C) Prevent pooling of skin prep solutions.
D) Adjust patient position during the procedure to ensure tissue perfusion.
E) Observe and document skin integrity and conditions postoperatively; compare with preoperative status.

Question 23

A 53-year-old male smoker with hemoptysis and dyspnea had an outpatient bronchoscopy.He is very concerned about the results of the biopsies and possible diagnosis.The nurse is preparing the patient and his wife for discharge and reviewing specific instructions related to his bronchoscopy.What points does the nurse include in the plan for discharge education for him and his family?

A) The patient and family should be aware of the length of time until results will be available and the method used to obtain those results.
B) The patient should be reminded that his throat might feel numb 2 to 3 hours after the procedure and difficulty with swallowing will subside.
C) The patient should demonstrate checking the gag reflex to determine when normal safe swallowing returns, and food and fluids can be resumed.
D) The patient should be instructed to seek emergency care if he has trouble breathing, sudden chest pain, palpitations, uncontrollable cough, or bloody sputum.
E) The patient should be reminded of the need to rest for 2 to 3 days after the procedure.