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The nurse has admitted a patient who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue?
- A. Pulmonary function studies
- B. Exercise tolerance tests
- C. Arterial blood gas values
- D. Chest x-ray
Correct Answer: A
Rationale: Pulmonary function studies are performed to determine whether the planned resection will leave sufficient functioning lung tissue. ABG values are assessed to provide a more complete picture of the functional capacity of the lung. Exercise tolerance tests are useful to determine if the patient who is a candidate for pneumonectomy can tolerate removal of one of the lungs. Preoperative studies, such as a chest x-ray, are performed to provide a baseline for comparison during the postoperative period and to detect any unsuspected abnormalities.
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The nurse is preparing to discharge a patient after thoracotomy. The patient is going home on oxygen therapy and requires wound care. As a result, he will receive home care nursing. What should the nurse include in discharge teaching for this patient?
- A. Safe technique for self-suctioning of secretions
- B. Technique for performing postural drainage
- C. Correct and safe use of oxygen therapy equipment
- D. How to provide safe and effective tracheostomy care
Correct Answer: C
Rationale: Respiratory care and other treatment modalities (oxygen, incentive spirometry, chest physiotherapy [CPT], and oral, inhaled, or IV medications) may be continued at home. Therefore, the nurse needs to instruct the patient and family in their correct and safe use. The scenario does not indicate the patient needs help with suctioning, postural drainage, or tracheostomy care.
What would the critical care nurse recognize as a condition that may indicate a patients need to have a tracheostomy?
- A. A patient has a respiratory rate of 10 breaths per minute
- B. A patient requires permanent ventilation
- C. A patient exhibits symptoms of dyspnea
- D. A patient has respiratory acidosis
Correct Answer: B
Rationale: A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed patient. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.
The home care nurse is assessing a patient who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the patient in the home environment?
- A. The patient desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min
- B. The patient requires a high-flow system for use with a tracheostomy collar
- C. The patient desires a portable oxygen delivery system that can deliver 2 L/min
- D. The patient's respiratory status requires a system that provides an FiO2 of 65%
Correct Answer: C
Rationale: The use of oxygen concentrators is another means of providing varying amounts of oxygen, especially in the home setting. They can deliver oxygen flows from 1 to 10 L/min and provide an FiO2 of about 40%. They require regular maintenance and are not used for high-flow applications. The patient desiring a portable oxygen delivery system of 2 L/min will benefit from the use of an oxygen concentrator.
A patient has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the patient discouraged and saddened. The client states, I am recovering so slowly. I really thought I would be better by now. What nursing action should the nurse prioritize?
- A. Provide emotional support to the patient and family
- B. Schedule a visit to the patients primary physician within 24 hours
- C. Notify the physician that the patient needs a referral to a psychiatrist
- D. Place a referral for a social worker to visit the patient
Correct Answer: A
Rationale: The recovery process may take longer than the patient had expected, and providing support to the patient is an important task for the home care nurse. It is not necessary, based on this scenario, to schedule a visit with the physician within 24 hours, or to get a referral to a psychiatrist or a social worker.
Postural drainage has been ordered for a patient who is having difficulty mobilizing her bronchial secretions. Before repositioning the patient and beginning treatment, the nurse should perform what health assessment?
- A. Chest auscultation
- B. Pulmonary function testing
- C. Chest percussion
- D. Thoracic palpation
Correct Answer: A
Rationale: Chest auscultation should be performed before and after postural drainage in order to evaluate the effectiveness of the therapy. Percussion and palpation are less likely to provide clinically meaningful data for the nurse. PFTs are normally beyond the scope of the nurse and are not necessary immediately before postural drainage.