CA.

LUNG
1

A female client diagnosed with lung cancer is to have a left lower lobectomy. Which of
the following assessment findings obtained during the nurses admission interview would
increase the clients risk of developing post operative pulmonary complications?
a Height is 5 feet, 7 inches and weight is 110kb
b The client tends to keep her real feelings to herself
c She ambulates and can climb one flight of stairs without dyspnea
d The client is 58 years of age
Ans: a. risk factors for postoperative pulmonary complications include
malnourishment, which is indicated by this clients height and weight. It
is thought that emotional responses can affect overall health; however,
not verbalizing ones feeling is not a contributing factor in postoperative
pulmonary complications. The clients current acivity level and age do
not place her at increased risk for complications.

2 The nurse in the perioperative area is preparing a client for surgery and notices that the
client looks sad. The client says, Im scared of having cancer. Its so horrible and I
brought it on myself. I should have quit smoking years ago. What would be the nurses
best response to the client?
a Its okay to be scared. What is it about cancer that youre afraid of?
b Its normal to be scared. I would be, too. Well help you through it
c Dont be so hard on yourself. You dont know if your smoking caused
the cancer
d Do you feel guilty because you smoked
Ans: a. acknowledging the basic feeling the client expresses fear and
asking and open ended question allows the client to explain any fears.
The other options dismiss the clients feelings and may give false
reassurance or label the clients feelings. The client should be
encouraged to explore feelings about a cancer diagnosis.
3 A client who underwent a left lower lobectomy has been out of surgery for 48 hours. She
is receiving morphine sulfate via a patient controlled analgesia (PCA) system. She
complaints of moderately severe pain in her left thorax that worsens when she coughs.
The nurse should:
a Let the client rest, so that she is not stimulated to cough
b Encourage the client to take deep breaths to help control the pain
c Check that the PCA device is functioning properly, and then reassure the
client that the machine is working and will relieve her pain.
d Assess the pain systematically with the hospital approved scale.
Ans: d. systematic pain assessment is necessary for adequate pain
management in the postoperative client. Guidelines from a variety of
health care agencies and nursing groups recommend that institutions
adopt a pain assessment scale to assist in facilitating pain management.
Even though the client is receiving morphine sulfate by PCA, assessment
is needed if she is experiencing pain. The concern is not to eliminate

coughing but to control pain adequately. Coughing is necessary to

prevent postoperative atelectasis and pneumonia. Breathing exercises
may help control pain in some circumstances; however, most clients with
thoracic surgery require parenteral opioid analgesics in the early
postoperative period. Although it is necessary that the PCA device be
checked periodically to ensure that it is functioning properly, if the
machine is functional and the clients pain is not relieved, further
intervention, beginning with a pain assessment, is indicated.
4 Which of the following areas is a priority to evaluate when completing discharge planning
for a client who has had a lobectomy for treatment of lung cancer?
a The support available to assist the client at home
b The distance the client lives from the hospital
c The clients ability to do home blood pressure monitoring
d The clients knowledge of the causes of lung cancer
Ans: a. because clients are discharged as soon as possible from the
hospital, it is essential to evaluate the support they have to assist them
with self care at home. The distance the client lives from the hospital is
not a critical factor in discharge planning. There are no data indicating
that home blood pressure monitoring is needed. Knowledge of the
causes of lung cancer, although important, is not the most essential area
to evaluate given the clients postoperative status.
5 Which of the following would be a major intervention to help prevent lung cancer?
a Encourage cigarette smokers to have yearly chest radiographs
b Instruct people about techniques for smoking cessation
c Recommend that people have their houses and apartments checked for
asbestos leakage
d Encourage people to install central air cleaners in their homes
Ans : b. epidermoid cancer involving the larger bronchi is almost entirely
associated with heavy cigarette smoking. The American Cancer Society
reports that smoking is responsible for more than 80% of lung cancers in
men and women. The prevalence of lung cancer is related to the duration
and intensity of the smoking, so nurses can best prevent lung cancer by
persuading clients to stop smoking. Chest radiographs aid in detection of
lung cancer; they do not prevent it. Exposure to asbestos has been
implicated as a risk factor for lung cancer, but cigarette smoking is the
major risk factor. There are no data to support the sue of home air
cleaners in the prevention of lung cancer.
6 After a thoracotomy, clients should be instructed to perform deep breathing exercises
for which of the following reasons?
a Deep breathing elevates the diaphragm, which enlarges the thorax and
increases the lung surface available for gas exchange
b Deep breathing increases blood flow to the lungs to allow them to
recover from the trauma of surgery
c Deep breathing controls the rate of air flow to the remaining lobe so that
it will not become hyperinflated

d Deep breathing expands the alveoli and increases the lung surface
available for ventilation
Ans : d. deep breathing helps prevent microatelectasis and pneumonitis
and also helps force air and fluid out of the pleural space into the chest
tubes. More than half of the ventilatory process is accomplished by the
rise and fall of the diaphragm. The diaphragm is the major muscle of
respiration; deep breathing causes it to descend , not elevate, thereby
increasing the ventilating surface. Deep breathing increases blood flow
to the lungs; however, the primary reason for deep breathing is to
expand alveoli and prevent atelectasis. The remaining lobe naturally
hyperinflates to fill the space created by the resected lobe. This ia an
expected phenomenon.
7 Which of the following is the most important aspect of pain management for the client
after a thoracotomy?
a Repositioning the client immediately after administering pain medication
b Reassessing the client 30 minutes after administering pain medication
c Verbally reassuring the client after administering pain medication
d Readjusting the pain management dosage as needed according to the
clients condition.
Ans: b. it is essential that the nurse evaluate the effects of pain
medication after the medication has had time to act; reassessment is
necessary to determine the effectiveness of the pain management plan.
Although it is prudent to check for discomfort related to positioning
when assessing the clients pain, repositioning the client immediately
after administering pain medication is not necessary. Verbally reassuring
the client after administering pain medication may be useful to help
instill confidence in the treatment plan; however, it is not as important
as evaluating the effectiveness of the medication. Readjusting the pain
medication dosage as needed according to the clients conditional is
essential, but the effectiveness of the medication must be evaluated
first.
8 Which assessing a thoracotomy incisional area from which a chest tube exits, the nurse
feels a crackling sensation under the fingertips along the entire incision. Which of the
following should be the nurses first action?
a Lower the head of the bed and call the physician
b Prepare an aspiration tray
c Mark the area with a skin pencil at the outer periphery of the crackling
d Turn off the suction of the chest drainage system
Ans: c. this crackling sensation is subcutaneous emphysema.
Subcutaneous emphysema is not an unusual finding, and it is not
dangerous if confined. But progression can be serious, especially if the
neck is involved; a tracheotomy may be needed. If emphysema
progresses noticeably in 1 hour, the physician should be notified.
Lowering the head of the bed will not arrest the progress or provide any
further information. A tracheotomy tray would be useful if subcutaneous

emphysema progresses to the neck. Subcutaneous emphysema may

progress if the chest drainage system does not adequately remove air
and fluid; therefore , the system should not be turned off.
9 When teaching a client to deep breathe effectively after a lobectomy, the nurse should
instruct the client to do which of the following?
a Contract the abdominal muscles, take a slow deep breath through the
nose and hold it for 3 to 5 seconds, then exhale
b Contract the abdominal muscles, take a deep breath through the mouth,
and exhale slowly as if trying to blow out a candle
c Relax the abdominal muscles, take a slow deep breath through the nose,
and hold it for 3 to 5 seconds.
d Relax the abdominal muscles, take a deep breath through the mouth,
and exhale slowly over 10 seconds.
Ans: a. the recommended procedure for teaching clients postoperatively
to deep breathe includes contracting (pulling in) the abdominal muscles
and taking a slow, deep breath through the nose. This breath is held 3 to
5 seconds, which facilitates alveolar ventilation by improving the
inspiratory phase of ventilation. Exhaling slowly as if trying to blow out a
candle is a technique used in pursed lip breathing to facilitate
exhalation in clients with COPD. It is recommended that the abdominal
muscles be contracted, not relaxed, to promote deep breathing. The
client should breathe through the nose.
10 Which of the following rehabilitative measures should the nurse teach the client who has
undergone chest surgery to prevent shoulder ankylosis?
a Turn from side to side
b Raise and lower the head
c Raise the arm on the affected side over the head
d Flex and extend the elbow on the affected side
Ans: c. a client who has undergone chest surgery should be taught to
raise the arm on the affected side over the head to help prevent
shoulder ankylosis. This exercise helps restore normal shoulder
movement, prevents stiffening of the shoulder joint, and improves
muscle tone and power. Turning from side to side, raising and lowering
the head, and flexing and extending the elbow on the affected side do
not exercise the shoulder joint.
11 When caring for a client with a chest tube and water seal drainage system, the nurse
should implement which of the following interventions?
a Verify that the air vent on the water seal drainage system is capped
when the suction is off
b Strip the chest drainage tubes at least every 4 hours if excessive
bleeding occurs
c Ensure that the chest tube is clamped when moving the client out of the
bed
d Make sure that the drainage apparatus is always below the clients chest
level

Ans: d. the drainage apparatus is always kept below the clients chest
level to prevent back flow of fluid into the pleural space. The air vent
must always be open in the closed chest drainage system to allow air
from the client to escape. Stripping a chest tube causes excessive
negative intrapleural pressure and is not recommended. Clamping a
chest tube when moving a client is not recommended.
12 A client has a chest tube attached to water seal drainage system and the nurse notes
that the fluid in the chest tube and in the water seal column has stopped fluctuating.
Which of the following is the explanation?
a The lung has fully expanded
b The lung has collapsed
c The chest tube is in the pleural space
d The mediastinal space has decreased
Ans: a. cessation of fluid fluctuation in the tubing can mean one of
several things: the lung has fully expanded and negative intrapleural
pressure has been re established; the chest tube is occluded; or the
chest tube is not in the pleural space. Fluid fluctuation occurs because,
during inspiration, intrapleural pressure exceeds the negative pressure
generated in the water seal system. Therefore, drainage moves
towards the client. During expiration, the pleural pressure exceeds that
generated in the water seal system, and fluid moves away from the
client. When the lung is collapsed or the chest tube is in the pleural
space, fluid fluctuation is likely to be noted. The chest tube is not
inserted in the mediastinal space.
13 The nurse observes a constant gentle bubbling in the water seal column of a water
seal chest drainage system. This observation should prompt the nurse to do which of the
following?
a Continue monitoring as usual; this is expected
b Check the connectors between the chest and drainage tubes and where
the drainage tube enters the collection bottle
c Decrease the suction to -15 cm H2O and continue observing the system
for changes in bubbling during the next several hours
d Drain half of the water from the water seal chamber
Ans: b. there should never be constant bubbling in the water seal
bottle; normally the bubbling is intermittent. Constant bubbling in the
water seal bottle indicates an air leak, which means that less negative
pressure is being exerted on the pleural space. Decreasing the suction or
draining part of the water in the water seal chamber will not reduce the
leak.
14 A client who underwent a lobectomy and has a water seal chest drainage system is
breathing with a little more effort and at a faster rate than 1 hour ago. The clients pulse
rate is also increased. Which of the following actions should the nurse implement?
a Check the tubing to ensure that the client is not lying on it or kinking it.
b Increase the suction
c Lower the drainage bottles 2 to 3 feet below the level of the clients
chest

d Ensure that the chest tube has two clamps on it to prevent air leaks.
Ans: a. in this case, there may be some obstruction to the flow of air and
the fluid out of the pleural space, causing air and fluid to collect and
build up pressure. This prevents the remaining lung from re expanding
and can cause a mediastinal shift to the opposite side. The nurses first
response is to assess the tubing for kniks or obstruction. Increasing the
suction is not done without a physicians order. The normal position of
the drainage bottles is 2 to 3 feet below the chest level. Clamping the
tubes obstructs the flow of air and fluid out of the pleural space and
should not be done.
15 Which of the following should be readily available at the bedside of a client with a chest
tube in place?
a A tracheostomy tray
b Another sterile chest tube
c A bottle of sterile water
d A spirometer
Ans: c. a bottle of sterile water should be readily available and in view
when a client has a chest tube so that the tube can be immediately
submersed in the water if the chest tube system becomes disconnected.
The chest tube should be reconnected to the water seal system as soon
as a sterile functioning system can be re established. There is no need
for a tracheostomy tray, another chest tube, or a spirometer to be placed
at the bedside for emergency use.