Breast Cancer

3. Provide resources for a wig selection before hair loss begins. Rationale: Resources should be provided for acquiring a wig since it is easier to match hair style and color before hair loss begins. The client has expressed negative feelings of self image with hair loss. Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3 to 4 weeks after the chemotherapy is fi nished, however new hair may have a new color or texture. A wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be avoided and the client should be encouraged to socialize with others.

38. Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is distressed about hair loss. The nurse should do which of the following? 1. Have the client wash and massage the scalp daily to stimulate hair growth. 2. Explain that hair loss is temporary and will quickly grow back to its original appearance. 3. Provide resources for a wig selection before hair loss begins. 4. Recommend that the client limit social contacts until hair regrows.

3. "This medication can be taken to prevent and treat clients with breast cancer." Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

. Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1. "This medication can be used only to treat breast cancer." 2. "Yes, your family member can take this medication for bladder cancer as well." 3. "This medication can be taken to prevent and treat clients with breast cancer." 4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."

3. An oral cathartic until the client has a bowel movement; then evaluate the need for daily stool softeners. Rationale: Constipation lasting 3 days or longer is unusual in this client and warrants immediate action. However, because the client had chemotherapy with doxorubicin (Adriamycin) 10 days ago, she is susceptible to infection and should avoid rectal medications and treatments. Abdominal discomfort secondary to constipation will be relieved after the client has a bowel movement; an opioid would contribute to the constipation

101. A client with breast cancer has abdominal bloating and cramping with no bowel movement for 5 days. She says she usually has a bowel movement every day after her morning coffee. Bowel sounds are present in all four quadrants. She received 80 mg of doxorubicin hydrochloride (Adriamycin) 10 days ago. The nurse should contact the health care provider to request an order for which of the following? 1. A Fleet enema to stimulate peristalsis. 2. A soapsuds enema until clear. 3. An oral cathartic until the client has a bowel movement; then evaluate the need for daily stool softeners. 4. A daily stool softener for constipation and a mild opioid for abdominal discomfort.

2. Support systems and coping strategies. Rationale: The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decision making abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation.

107. A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with: 1. Denial as a primary coping mechanism. 2. Support systems and coping strategies. 3. Decision-making abilities. 4. Transportation and money for the boys.

3. "Tell me more about your feelings on this." Rationale: The nurse should respond with an openended statement that elicits further exploration of the client's feelings. Women with cancer may feel guilt or shame. Previous life decisions, sexuality, and religious beliefs may infl uence a client's adjustment to a diagnosis of cancer. The nurse should not contradict the client's feelings of punishment or offer advice such as confiding in the husband. A social worker referral may be beneficial in the future, but is not the first response needed to elicit exploration of the client's feelings.

32. During the postoperative period after a modified radical mastectomy, the client confides in the nurse that she thinks she got breast cancer because she had an abortion and she did not tell her husband. The best response by the nurse is which of the following? 1. "Cancer is not a punishment; it is a disease." 2. "You might feel better if you confided in your husband." 3. "Tell me more about your feelings on this." 4. "I can have the social worker talk to you if you would like."

2. "This drug has been found to decrease metastatic breast cancer." Rationale: Tamoxifen is an antiestrogen drug that has been found to be effective against metastatic breast cancer and to improve the survival rate. The drug causes hot fl ashes as an adverse effect.

35. The client with breast cancer is prescribed tamoxifen (Nolvadex) 20 mg daily. The client states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. The nurse's best response is which of the following? 1. "This drug is part of your chemotherapy program." 2. "This drug has been found to decrease metastatic breast cancer." 3. "This drug will act as an estrogen in your breast tissue." 4. "This drug will prevent hot flashes since you cannot take hormone replacement."

4. Disturbance in his sleep patterns. Rationale: Depression can be a mixture of affective responses (feelings of worthlessness, hopelessness, sadness), behavioral responses (appetite changes, withdrawal, sleep disturbances, lethargy), and cognitive responses (decreased ability to concentrate, indecisiveness, suicidal ideation). Increased decisiveness, problem-solving ability, and increased social interactions are refl ective of adaptive coping.

A 42-year-old client with breast cancer is concerned that her husband is depressed by her diagnosis. Which of the following changes in her husband's behavior may confirm her fears? 1. Increased decisiveness. 2. Problem-focused coping style. 3. Increase in social interactions. 4. Disturbance in his sleep patterns.

4. Stop smoking, use sun protection, and lose weight. Rationale: The client is at increased risk for development of lung, skin, or breast cancer. Consequently, the most urgent changes in behavior should include smoking cessation, protection from the sun, and weight loss. Decreasing alcohol consumption is certainly desirable, as is improving overall nutritional intake (e.g., eating low-fat foods, increasing fiber) but is not the most urgent behavior change for this client.

A 42-year-old female highway construction worker is concerned about her cancer risks. She reveals that she has been married for 18 years, has two children, smokes one pack of cigarettes per day, and drinks one to two beers with her husband after work almost every day. She is 30 lb overweight, eats fast food often, and rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What combination of behavioral changes should the nurse instruct this client to make first? 1. Decrease fat in the diet, decrease alcohol consumption, and use sunscreen every day. 2. Decrease intake of salt-cured food, lose weight, and stop smoking. 3. Stop drinking beer, decrease fiber in the diet, and use sun protection. 4. Stop smoking, use sun protection, and lose weight.

4. Begin education about strategies for communication with his children. Rationale: Without clear, consistent communication, the parent-child relationship may become strained during the illness and subsequent death of a parent. A great number of parents do not know how to communicate with their children, especially about diffi cult emotional topics at a time when they are also under great emotional stress. The nurse should begin by providing information and developmentally appropriate books about the grieving process for children.

A 42-year-old husband and father of a 7-year-old girl and a 10-year-old boy is concerned about what he should tell his children regarding his wife's impending death from aggressive breast cancer. The nurse should: 1. Refer the family to pastoral care services. 2. Encourage the husband to come to terms with his own grief first. 3. Suggest that the children be told nothing until after death occurs. 4. Begin education about strategies for communication with his children.

4. Esophagitis. Rationale: Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall. Hiatal hernia is a herniation of a portion of the stomach into the esophagus. The client could experience burning and tightness in the chest secondary to a hiatal hernia, but not pain when swallowing. Also, hiatal hernia is not a complication of radiation therapy. Stomatitis is an inflammation of the oral cavity characterized by pain, burning, and ulcerations. The client with stomatitis may experience pain with swallowing, but not burning and tightness in the chest. Radiation enteritis is a disorder of the large and small bowel that occurs during or after radiation therapy to the abdomen, pelvis, or rectum. Nausea, vomiting, abdominal cramping, the frequent urge to have a bowel movement, and watery diarrhea are the signs and symptoms.

A 56-year-old female is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The nurse should further assess the client for indications of: 1. Hiatal hernia. 2. Stomatitis. 3. Radiation enteritis. 4. Esophagitis.

1. Seven. Rationale: If the maximum dose specified by the physician's order is required every 3 to 4 hours for break-through pain, the physician should be notified to increase the long-acting medication or rotate to another type of opioid. Around-the-clock dosing is mandatory to achieve a steady state of analgesia. The rescue dose for breakthrough pain is administered over and above the regularly scheduled medication. If three to four analgesic doses are required every 24 hours, the sustained-release around-the-clock dose should be increased to include the amount used for previous breakthrough pain while maintaining a dose for future breakthrough pain.

A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as needed for breakthrough pain. The physician should be notified if the client uses more than how many breakthrough doses of morphine in 24 hours? 1. Seven. 2. Four. 3. Two. 4. One.

2. "The incidence of breast cancer increases with age." Rationale: Advancing age in postmenopausal women has been identifi ed as a risk factor for breast cancer. A 76-year-old client needs monthly breast self-examination and a yearly clinical breast examination and mammogram to comply with the screening schedule. While mammograms are less painful as breast tissue becomes softer, the nurse should advise the woman to have the mammogram. Family history is important, but only about 5% of breast cancers are genetic.

A 76-year-old client tells the nurse that she has lived long and does not need mammograms. Which is the nurse's best response? 1. "Having a mammogram when you are older is less painful." 2. "The incidence of breast cancer increases with age." 3. "We need to consider your family history of breast cancer first." 4. "It will be sufficient if you perform breast examinations monthly."

4. Apply deodorant only under the left arm. Rationale: Hot, cold, and chemical applications to the area treated should be avoided. The client should be encouraged to use the extremity to prevent muscle atrophy and contractures.

A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which of the following should the nurse include in client teaching? 1. Use a heating pad under the right arm. 2. Immobilize the right arm. 3. Place ice on the area after each treatment. 4. Apply deodorant only under the left arm.

2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. "The sentinel node biopsy can decrease the number of axillary lymph nodes that must be removed during surgery." Rationale: An SLNB helps to identify axillary node involvement before axillary dissection has occurred. If the sentinel node is identified and is found to be negative for tumor cells, then further axillary lymph node dissection is unnecessary. Thus the lymph drainage of the involved arm can be preserved.

A client with newly diagnosed breast cancer asks a nurse to explain the advantages of a sentinel lymph node biopsy (SLNB). Which explanation should the nurse state to the client? 1. "The sentinel node biopsy improves the potential that the total tumor will be removed." 2. "The sentinel node biopsy can decrease the number of axillary lymph nodes that must be removed during surgery." 3. "The sentinel node biopsy makes breast reconstruction easier to perform." 4. "The sentinel node biopsy, if performed, will make hormonal therapy unnecessary."

4. To allow her mother to continue in her role as a mother. Rationale: Denial is a defense mechanism used to shut out a situation that is too frightening or threatening to tolerate. In this case, denial allows the client to vacillate between acceptance of the illness and its treatment and denial of the actual or potential seriousness of the disease. This may allow the client more psychological freedom to maintain her current roles in the family and elsewhere. Denial can be harmful if the client ignores standard medical therapies in favor of unconventional treatments. Denial is not helpful when it interferes with a client's willingness to seek treatment or make decisions about care. Using any one defense mechanism exclusively usually refl ects maladaptive coping. Other defense mechanisms that may be used include regression, humor, and sublimation.

A daughter is concerned that her mother is in denial when discussing her diagnosis of breast cancer because she sometimes says that breast cancer isn't that serious and changes the subject. The nurse informs the daughter that denial can be a healthy defense mechanism if it is used: 1. To permit her mother to seek unconventional treatments. 2. When making decisions about her care. 3. Alone and not in combination with other defense mechanisms. 4. To allow her mother to continue in her role as a mother.

1. "Women at average risk for breast cancer should begin having mammography at age 40." Rationale: Mammography for cancer screening should be completed annually beginning at age 40 or younger for high-risk women.

A nurse evaluates that a client correctly understands information regarding breast cancer screening when the client states: 1. "Women at average risk for breast cancer should begin having mammography at age 40." 2. "Women with fibrocystic breast disease should eliminate chocolate and caffeine from the diet." 3. "Women should perform monthly breast self examination (BSE)." 4. "Only women with fibrocystic breast disease should have the addition of breast ultrasound or MRI."

2. "Have you had nausea or vomiting?" Rationale: Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

A nurse is assessing a female who is receiving her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain? 1. "Has your hair been falling out in clumps?" 2. "Have you had nausea or vomiting?" 3. "Have you been sleeping at night?" 4. "Do you have your usual energy level?"

4. a drug that blocks estrogen receptors on tumor cells and causes tumor regression. Rationale: Tamoxifen is recommended as a primary prevention modality for women at high risk for breast cancer. It blocks estrogen receptors on tumor cells, and thus the cell growth declines and the tumor regresses.

A nurse is conducting a breast cancer awareness seminar at a local church. After the seminar, a 40-year-old female tells the nurse that she is at high risk for developing breast cancer and her health-care provider suggests that she begin taking tamoxifen (Soltamox®). She asks the nurse to explain how this drug will help her avoid developing breast cancer. The nurse's response should be based on the knowledge that tamoxifen is: 1. a potent anti-inflammatory drug that prevents the body's inflammatory response to the tumor growth. 2. a type of chemotherapy agent that has minimal side effects if taken prophylactically. 3. a drug that will decrease the risk of endometrial cancer, which is related to breast cancer development. 4. a drug that blocks estrogen receptors on tumor cells and causes tumor regression.

3. Benign fibroadenomas are the most frequent cause of breast masses in women under 25 years. Rationale: Fibroadenomas are the most common benign breast neoplasm, and most often occur in women younger than 25 years.

A nurse is conducting a health history interview with a 20-year-old college sophomore when the client starts crying and says, "I'm so worried. I found a lump in my breast last night and I'm scared I might have cancer!" Which fact should the nurse consider when formulating a response to the client? 1. Young women are at increased risk to develop breast cancer. 2. A non discrete possible mass or thickening has a high index of suspicion for breast cancer. 3. Benign fibroadenomas are the most frequent cause of breast masses in women under 25 years. 4. College students often develop infectious breast disorders due to the close personal contact required in dormitory living.

2. The longer the interval between menarche and menopause, the more the risk increases. 3. Nulliparous women are at increased risk. 5. Women whose sisters or mothers have had breast cancer are at increased risk. Rationale: Early menarche and/or late menopause increase the risk of developing breast cancer. Childless women are at increased risk as are women with first-degree relatives, such as a mother or sister, who had breast cancer.

A nurse is preparing to conduct a women's wellness seminar at a local civic center. What information should the nurse plan to include about risk factors for development of breast cancer? SELECT ALL THAT APPLY. 1. Breast cancer occurs most frequently in women younger than 30 years. 2. The longer the interval between menarche and menopause, the more the risk increases. 3. Nulliparous women are at increased risk. 4. Risk is increased in postmenopausal women with body mass indexes below 20. 5. Women whose sisters or mothers have had breast cancer are at increased risk. 6. The risk increases for women with fibrocystic breast disease.

1. Lymphedema is characterized by severe swelling in the arm and hand on the affected side. Rationale: Lymphedema is a chronic condition characterized by extreme edema in the involved extremity. The lymph circulation is disrupted by the lymph node dissection (even 20% of persons with sentinel node biopsy develop lymphedema) that is part of the treatment of breast cancer. Collateral lymph circulation does not develop. Lymphedema is best controlled by wearing compression sleeves and/or gloves. Lymphedema occurs from the lymph node dissection and is not associated with recurrence of the malignancy.

An experienced nurse tells a new nurse that lymphedema is a complication that commonly occurs after women have received surgery for breast cancer. Which statement to the new nurse regarding lymphedema is correct? 1. Lymphedema is characterized by severe swelling in the arm and hand on the affected side. 2. Lymphedema usually resolves after the cancer treatment is completed when collateral lymph circulation develops. 3. Lymphedema is mainly controlled by encouraging women to keep their arm elevated. 4. Lymphedema frequently signifies that there is a recurrence of the malignancy.

1. "I guess I won't be here to see our daughter graduate this spring." Rationale: Ninety percent of women with localized tumors (stage 1 and 2) can be expected to achieve long-term disease-free survival.

An oncologist tells a nurse that he has informed a client that her breast cancer is stage 1. After overhearing the client talking with her husband, the nurse determines that the client has not fully understood the diagnosis. Which statement was most likely made by the client to her husband? 1. "I guess I won't be here to see our daughter graduate this spring." 2. "I understand that I will need some type of chemotherapy." 3. "I will be starting radiation therapy soon." 4. "I think I have a good chance to be a 5-year survivor."

2. Early menarche 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries Rationale: Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; highdose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer.

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. 1. Multiparity 2. Early menarche 3. Early menopause 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries

1. 2000 mm3 (2.0 × 10 9 /L) Rationale: The normal WBC count ranges from 5000 to 10,000 mm3 (5 to 10 × 10 9 /L). The client who has a decrease in the number of circulating WBCs is immunosuppressed. The nurse implements neutropenic precautions when the client's values fall sufficiently below the normal level. The specific value for implementing neutropenic precautions usually is determined by agency policy. The remaining options are normal values.

The nurse is caring for a client with a diagnosis of breast cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the client's white blood cell count was which value? 1. 2000 mm3 (2.0 × 10 9 /L) 2. 5800 mm3 (5.8 × 10 9 /L) 3. 8400 mm3 (8.4 × 10 9 /L) 4. 11,500 mm3 (11.5 × 10 9 /L)

3. Breast cancer concerns vary between socioeconomic levels of African American women. Rationale: The nurse needs to consider the beliefs and concerns for all socioeconomic levels of African American women when providing education on breast cancer. Access to screening and care may differ. African American women are more likely to develop breast cancer and be diagnosed later in the disease process than Caucasian women. Not all African American women believe that breast cancer is inevitable.

The nurse is preparing an educational program on breast cancer for women at an African American community center. What information is important for the nurse to consider for the discussion? 1. African American women have the lowest rate of breast cancer. 2. Most African American women are diagnosed early in the disease process. 3. Breast cancer concerns vary between socioeconomic levels of African American women. 4. African American women believe breast cancer is inevitable.

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Rationale: Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

1. Male-to-female (MTF) 2. Female-to-male (FTM) 4. Women-who-have-sex-with-men (WSM) 5. Women-who-have-sex-with-women (WSW) Rationale: Transgender persons who have undergone sexual reassignment surgery should have the respective preventive screenings. For example, MTF should have breast cancer screening by way of mammography if they are older than 50 years. Additionally, FTM should still have mammography routinely as indicated due to the risk for residual breast tissue to develop cancerous growth. WSW and WSM should have screening as well.

Which special population should be targeted for breast cancer screening by way of mammography? Select all that apply. 1. Male-to-female (MTF) 2. Female-to-male (FTM) 3. Men-who-have-sex-with-men (MSM) 4. Women-who-have-sex-with-men (WSM) 5. Women-who-have-sex-with-women (WSW)