Chapter 22 Thoracic Surgery

Chapter 22  Thoracic Surgery

MULTIPLE CHOICE

1. 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?

1. Brachial plexus palsy
2. Vertebral tipping syndrome
3. Thoracic outlet syndrome
4. Thoracic plexus compression

ANS: C
Compression of these structures causes thoracic outlet syndrome.

REF: Page 936

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

1. The bronchi and the blood vessels
2. The alveoli and the pulmonary vein
3. The pulmonary artery and vein
4. The bronchi and bronchioles

ANS: A
The nerves of the lungs are a part of the autonomic nervous system. They regulate constriction and relaxation of the bronchi and the blood vessels within the lungs.

REF: Pages 936-937

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?

1. The lungs recoil and expand to draw air into them.
2. The lungs are passive and follow the diaphragm and chest wall.
3. The lungs produce a pressure gradient that suctions air.
4. The alveolar sacs expand when triggered by neural triggers in all 10 lung

   segments.

ANS: B

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 22-2

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.

REF: Page 938

4. 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.

1. The nurse should begin preparing the patient for nicotine withdrawal.
2. The nurse should avoid making assumptions about smoking and a cancer

   diagnosis.

3. The nurse should note packs/day consumption to alert the surgeon to write

   postoperative orders for medication.

4. The nurse should phrase questions so as not to suggest guilt about smoking

   behaviors.

ANS: 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.

REF: Page 940

5. 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.

1. Decrease surgical time by anticipating needs of the patient and surgical team.
2. Collaborate in positioning the patient to provide access to the endotracheal tube, enable efficient ventilatory function, and prevent injury.
3. Obtain chest x-ray films for the intraoperative period.
4. Consult with the surgeon, requesting an order to repeat the laboratory tests

ANS: B

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 22-3

The nurse should collaborate in positioning the patient to provide access to the endotracheal tube, enable efficient ventilatory function, and prevent injury. Verify that a double-lumen endotracheal tube with a soft, inflatable cuff is available for the anesthesia provider. The nurse should collaborate in obtaining equipment and monitoring arterial blood gases (ABGs); document results. Obtain equipment and assist with patient preparation for hemodynamic monitoring: electrocardiogram (ECG), CO2 analyzer, pulse oximeter, arterial pressure line, and central venous pressure line; the nurse should collaborate with the anesthesia provider in evaluating results provided by these monitoring devices during the procedure.

REF: Pages 940, 942

6. 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?

1. Ensure adequate padding and safe transfer.
2. Check pulses and skin condition immediately after positioning.
3. Adjust patient position during the procedure to ensure tissue perfusion.
4. Document skin integrity and conditions postoperatively.

ANS: A
Adequate padding and safe transfer should be implemented to prevent pressure injury. Apply principles of positioning for efficient circulatory function for lateral or supine position during the procedure; pad and protect vulnerable neurovascular bundles and dependent pressure areas. Position the patient in the best possible body alignment to allow visualization of the operative field. Observe and document skin integrity and condition postoperatively and compare with preoperative status.

REF: Page 942