Deck 22: Thoracic Surgery

Question 1

Assessment of the skin and the patient's general condition is important in preventing perioperative complications.The nurse should assess the patient's smoking history (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 statement that best reflects an appropriate strategy that the nurse could use in assessing the 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 guilt 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.The nurse should also assess the patient's pain tolerance to determine necessary teaching or tools that will assist in achieving positive postoperative outcomes.

Question 2

Pleurodesis is undertaken as a treatment for malignant pleural effusion and for unresolved spontaneous pneumothorax.The endpoint 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.

Answer 2

D
A variety of chemical agents are used to cause adherence of the pleural layers.Adherence of the pleural layers is thought to prevent the accumulation of pleural fluid in the case of pleural effusion and to prevent subsequent pneumothoraces.

Question 3

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,what 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.

Answer 3

B
As the muscles of inspiration contract to enlarge the chest cage,the lungs passively follow the diaphragm and chest wall because of decreased intrathoracic pressure.The acts of inspiration and expiration are the result of air moving in and out of the lung,causing pressure to equalize with that of the atmosphere at the end of expiration.

Question 4

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 tests

Question 5

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 until resection is complete.

Question 6

The nerves of the lungs are a part of the autonomic nervous system.What 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 7

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 8

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 bronchoscopy
C) Rigid bronchoscopy
D) All bronchoscopic approaches apply

Question 9

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) Adjust patient position during the procedure to ensure tissue perfusion.
D) Document skin integrity and conditions postoperatively.

Question 10

Roger Waring,a 46-year-old male 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 Roger's 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.What diagnostic procedure will precede Roger's thoracoscopic lung surgery?

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

Question 11

Roger Waring'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.Roger's TNM and staging classification are:

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 12

Pneumonectomy is removal of an entire lung,usually to treat malignant neoplasms.What structures are excised or resected in order to remove the entire lung and complete the surgery?

A) A section of rib,bronchus,pulmonary artery and vein,and hilar pleura
B) The lung,peripheral adhesions,and pulmonary ligament
C) Mediastinal lymph nodes,portions of the chest wall or diaphragm,and parietal pleura
D) All of these structures may be resected during a pneumonectomy

Question 13

An example of a true statement about TNM and staging diagnostic classification for lung cancer is:

A) the staging system is based on the TNM classification system.
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 14

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) Severe bilateral heterogeneous or homogeneous emphysema
D) Unsuccessful or failed laser surgery for giant lung bulla

Question 15

The thoracic outlet is 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.The great vessels of the head,neck,and arm pass through this space.What syndrome is caused by the compression of these structures?

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

Question 16

Aaron Greenberg,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 to determine which agent will be used.She has an unsterile product that has been typically used in the past,but sterile processing informs her that they do not have the capacity to sterilize this agent.She also notes that the OR does not have a policy or guidelines for the administration of chemotherapeutic antineoplastic agents or safety training and a spill kit.Based on these conditions,what agent will the surgeon and nurse select for Mr.Greenberg's procedure?

A) Silver nitrate
B) Bleomycin
C) Talc powder
D) Cyclines

Question 17

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

Question 18

Thoracotomy can be performed with the patient in one of three common positions:lateral,semilateral,and supine.While the supine position is used for the median sternotomy approach,which of the lateral positions is used for an anterolateral approach?

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

Question 19

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 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)include 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

Carla Fortunato,a 38-year-old healthy nonsmoking woman with a suspicious lesion on the lateral margin of her right middle lobe,is having a thorascopic lung biopsy and has been selected and prepared for the ambulatory surgery center's fast track recovery and discharge program.The plan is that she will be discharged on postoperative day 2 with a chest tube and portable drainage system.The perioperative nurse has arrived to meet Carla,conduct the preoperative nursing assessment,and begin Carla's discharge education.After asking Carla if she has questions or any concerns,the nurse provides Carla with the important risk reduction strategies based on her procedure,condition,and postoperative expectations.What will be the primary focus of the nurse's teaching?

A) Diet,activity,pain management,and pulmonary hygiene
B) Wound care,coughing and deep breathing,and importance of fluid intake
C) Stripping the chest tube,dressing changes,and home medication administration
D) Pain management,chest tube management,and indications for emergency care

Question 22

Sandra Lewis,an experienced perioperative nurse,was called to the surgical intensive care unit to assist the thoracic surgery fellow with a chest tube reinsertion on a postoperative thoracotomy patient who sustained a pneumothorax on removal of his chest tube.Recognizing this as a teaching opportunity with several new graduate nurses and a medical student,Sandra reviewed several risk reduction strategies related to chest tube insertion.She positioned the opened sterile insertion tray near the surgeon's dominant hand.Which of the chest tube insertion risk reduction strategies should be Sandra's next priority?

A) Prevent contamination of the bed and fluid leakage.
B) Provide the patient verbal and physical comfort measures.
C) Employ Standard Precautions.
D) Avoid performing multiple procedures at the same time.

Question 23

Michael Stayman,a 53-year-old smoker with hemoptysis and dyspnea,had an outpatient bronchoscopy.His oxygen saturation remains below 90% on 2 L of oxygen.He is very concerned about the results of the biopsies and possible diagnosis.The pulmonologist has written an order for home oxygen to manage his dyspnea.The nurse is preparing Michael and his wife for discharge and reviewing specific instructions related to his bronchoscopy and home oxygen therapy.What does the nurse consider the most important aspect of education for Michael and his family?

A) Stress the importance of not smoking or allowing others to smoke near the patient because of the possibility of combustion,fire,or explosion.
B) Demonstrate checking the gag reflex to determine when normal safe swallowing returns and food and fluids can be resumed.
C) Make the patient and family aware of the length of time until biopsy results will be available and the method used to obtain those results.
D) Remind the patient of the need to rest for 2 to 3 days after the procedure.

Question 24

The perioperative nurse will need to collaborate with the anesthesia provider,since continuous hemodynamic monitoring,oximetry,and ventricular function assessment by transesophageal echocardiography (TEE)are all performed intraoperatively.Cardiopulmonary bypass (CPB)may also be required.Select all the procedures for which these preparations are indicated.

A) Donor harvesting
B) Living-related single-lung transplant
C) Cadaveric single-lung transplant
D) Double-lung transplant

Question 25

After successful reinsertion of the patient's chest tube,Sandra conducted a debriefing session with the new graduate nurses and medical student and asked several reflective questions about the follow-up care of the patient and chest tube.What would be an appropriate question to ask the new nurses and student about follow-up care?

A) How often should the chest tube be stripped?
B) How high should the chest drainage system be hung above the patient's waist?
C) Why do we check alignment of the patient's trachea?
D) Who is authorized to remove the chest tube?